Persistent opioid use is common after surgery, and patients with preoperative opioid use represent a major challenge in this regard. The aim of this randomized controlled trial was to determine the effect of a personalized opioid tapering plan vs standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Postoperative outcomes included opioid use, pain, contacts with the healthcare system, patient satisfaction, and withdrawal symptoms. Overall, 110 patients were randomized; 55 into the intervention and control groups each. Five patients (proportion = 0.09, 95% confidence interval [CI] [0.04-0.21]) in the intervention group compared with 13 patients (0.25, 95% CI [0.15-0.39]) in the control group were unable to taper opioids to their preoperative consumption 1 month after discharge (P = 0.03) (primary outcome). Likewise, more patients in the intervention group succeeded in tapering opioids to zero 3 months after discharge (37 patients; 0.71, 95% CI [0.57-0.82] vs 23 patients; 0.43, 95% CI [0.30-0.56], P = 0.003). Fewer patients in the intervention group had pain-related contacts to health care the first 2 weeks after discharge (21 patients; 0.40, 95% CI [0.28-0.54] vs 31 patients; 0.60, 95% CI [0.46-0.73], P = 0.04). There was no difference in satisfaction with pain treatment over the first 2 weeks or the incidence of withdrawal symptoms during the first month after discharge. Pain intensity was similar between both groups at all time points. These results suggest that a personalized tapering plan at discharge combined with telephone counselling 1 week after discharge assists patients in postoperative opioid tapering.

手术后持续使用阿片类药物很常见，术前使用阿片类药物的患者在这方面是一个重大挑战。这项随机对照试验的目的是确定个性化阿片类药物减量计划与护理标准对术前使用阿片类药物并接受脊柱手术的患者的影响在丹麦奥胡斯大学医院。术后结果包括阿片类药物的使用、疼痛、与医疗保健系统的接触、患者满意度和戒断症状。总体而言，110 名患者被随机分配；干预组和对照组各55人。干预组有 5 名患者（比例 = 0.09, 95% CI [0.04-0.21]），而对照组有 13 名患者（0.25, 95% CI [0.15-0.39]）无法逐渐减量阿片类药物至出院后 1 个月的术前消耗量（P = 0.03）（主要结果）。同样，干预组中有更多患者在出院后 3 个月成功将阿片类药物逐渐减量至零（37 名患者；0.71, 95% CI [0.57-0.82] vs 23 名患者；0.43, 95% CI [0.30-0.56], P= 0.003)。干预组中较少的患者在出院后的前 2 周与疼痛相关的医疗保健接触（21 名患者；0.40, 95% CI [0.28-0.54] vs 31 名患者；0.60, 95% CI [0.46-0.73], P = 0.04)。前 2 周对疼痛治疗的满意度或出院后第一个月的戒断症状发生率没有差异。两组在所有时间点的疼痛强度相似。这些结果表明，出院时的个性化减量计划与出院后 1 周的电话咨询相结合，有助于患者术后阿片类药物减量。