To the Editor:
I read with interest the article by Murphy et al.1 Their study was thought provoking in the context of reducing postoperative medication requirements in the midst of our nation’s opioid crisis. I was most interested in the results of the complex back surgery patients and their postoperative pain medication use.
Preoperative opioid use is not documented in their study. Previous studies have shown that preoperative use of opioids is one of the most important risk factors in long-term opioid use postoperatively.2 Without knowing which patients were taking preoperative opioids, it is difficult to interpret their postoperative analgesic requirements and frequency of use results.
This study examines the very interesting idea of adding perioperative methadone to reduce postoperative analgesic requirements. I am encouraged that the authors are pursuing innovations in enhanced recovery after surgery protocols to minimize postoperative pain and opioid use.
The author declares no competing interests.