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J Reconstr Microsurg 2022; 38(02): 137-143
DOI: 10.1055/s-0041-1731640
Original Article

Long-Term Opioid Use Following Surgery for Symptomatic Neuroma

Jonathan Lans
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston
,
Ritsaart F. Westenberg
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston
,
Rachel E. Gottlieb
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston
,
Ian L. Valerio
2   Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
,
Neal C. Chen
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston
,
Kyle R. Eberlin
2   Division of Plastic Surgery, Hand Surgery, and Peripheral Nerve Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
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Abstract

Background Identifying patients at risk for prolonged opioid use following surgery for symptomatic neuroma would be beneficial for perioperative management. The aim of this study is to identify the factors associated with postoperative opioid use of >4 weeks in patients undergoing neuroma surgery.

Methods After retrospective identification, 77 patients who underwent surgery for symptomatic neuroma of the upper or lower extremity were enrolled. Patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) depression, Numeric Rating Scale (NRS) pain score, and a custom medication questionnaire at a median of 9.7 years (range: 2.5–16.8 years) following surgery. Neuroma excision followed by nerve implantation (n = 39, 51%), nerve reconstruction/repair (n = 18, 23%), and excision alone (n = 16, 21%) were the most common surgical treatments.

Results Overall, 27% (n = 21) of patients reported opioid use of more than 4 weeks postoperatively. Twenty-three patients (30%) reported preoperative opioid use of which 11 (48%) did not report opioid use for >4 weeks, postoperatively. In multivariable logistic regression, preoperative opioid use was independently associated with opioid use of >4 weeks, postoperatively (odds ratio [OR] = 4.4, 95% confidence interval [CI]: 1.36–14.3, p = 0.013).

Conclusion Neuroma surgery reduces opioid use in many patients but patients who are taking opioids preoperatively are at risk for longer opioid use. Almost one-third of patients reported opioid use longer than 4 weeks, postoperatively.

Keywords

neuroma - opioid - neuroma surgery

Financial Disclosure Statement

R.F.W. and I.L.V. have nothing to disclose. J.L. is a consultant for AxoGen. N.C.C. is consultant for Flexion Medical, Miami Device Solutions, and a lecturer for DePuy Synthes. K.R.E is a consultant for AxoGen, Checkpoint and Integra. No funding was received for this article.


Authors' Contributions

Study design: J.L., R.F.W., N.C.C., and K.R.E.


Data assembly: J.L., R.F.W., and R.E.G.


Data analysis: J.L., R.F.W., N.C.C., and K.R.E.


Initial draft: J.L., R.F.W., I.L.V., N.C.C., and K.R.E.


Final approval of manuscript: J.L., R.F.W., R.E.G., I.L.V., N.C.C., and K.R.E.


Supplementary Material



Publication History

Received: 06 January 2021

Accepted: 12 May 2021

Article published online:
16 July 2021

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