Evaluating the Impact of Chronic Beta Blocker Use on Postoperative Opioid Consumption Following Lumbar Fusion: A Propensity Matched Analysis.

Abstract

Retrospective cohort. To investigate the impact of chronic beta blockers on opioid consumption following lumbar fusion. Intraoperative beta blockers have been proposed as opioid-sparing supplemental analgesics for spine surgery. In addition, recent arthroplasty literature has shown that long-term use of beta blockers decreases osteoarthritis-associated pain and the need for total joint replacement. However, the impact of similar long-term beta blocker use on pain control after lumbar fusion is unknown. A retrospective study of adult patients who underwent elective lumbar fusion was conducted (2014-2021). Patients were stratified based on whether or not they were chronic users of beta blockers before surgery. All beta-blocker patients continued these medications postoperatively. A 1:1 propensity match was performed based on age, sex, BMI, Charlson Comorbidity Index (CCI), Elixhauser, procedure type, surgical approach, and the number of levels fused. Morphine milligram equivalents (MME) were assessed preoperatively and postoperatively. Statistical analysis was performed with an alpha of 0.05. One hundred fifteen patients taking beta blockers were matched to 115 control patients. Patient groups were similar in terms of preoperative opioid use and baseline pain scores. Beta blocker use was associated with longer hospital length of stay (4.19±2.03 vs. 3.55±1.63, P=0.017). Otherwise, all postoperative outcomes were similar between groups. MME usage was similar across 30-day, 90-day, 1-year, and 2-year postoperative timepoints. Chronic beta blocker use was not associated with a difference in preoperative or postoperative opiate use at any time point up to 2 years after lumbar fusion. In contrast to prior work on intraoperative beta blockers in spine surgery and long-term beta blocker use in arthroplasty, the current data set suggests that long-term beta blocker use does not provide a protective effect for opioid consumption after lumbar fusion.