PDF herunterladen
J Neurol Surg B Skull Base 2022; 83(06): 594-601
DOI: 10.1055/s-0042-1744452
Review Article

Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

Tamia Potter
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Pranay Soni 
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Maria Krywyj
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Derrick Obiri-Yeboah
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
,
Precious Oyem
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
,
Arbaz Momin
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
,
Kathryn Easley
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
,
Pablo F. Recinos 
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
,
Varun R. Kshettry
2   Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
3   Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objective In 2017, the United States officially declared opioid overuse a public health emergency. Due to a paucity of published benchmark data in skull base neurosurgery, we quantified postoperative opioid use in patients undergoing skull base craniotomies and identified factors that influence postoperative opioid use.

Setting Tertiary academic medical center.

Participants Patients who underwent elective craniotomies by two skull base neurosurgeons between January 2015 and May 2020.

Main Outcome Measures Demographic and perioperative data were retrospectively extracted from the electronic medical record. Surgical approaches were categorized as having either “significant” or “minimal” muscle dissection. Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative opioid use at 24, 48, and 72 hours.

Results We included 300 craniotomies, 206 were supratentorial and 94 were infratentorial. This included 195 women and 105 men, with a mean age of 54.9 years. In multivariable analysis, a history of anxiety or depression, preoperative opioid use, and a history of migraines independently predicted a significantly greater opioid use at 24, 48, and 72 hours. Increased age and minimal muscle dissection independently predicted lower opioid consumption. Sex, infratentorial versus supratentorial approach, length of surgery, and postoperative steroid use did not impact total opioid use.

Conclusion Younger age, history of anxiety or depression, preoperative opioid consumption, preexisting history of migraines, and significant intraoperative muscle dissection were associated with higher postoperative opioid consumption. These risk factors provide insight on potential targets for minimizing postoperative opioids in craniotomies.

Keywords

opioid - craniotomy - skull base - pain


Publikationsverlauf

Eingereicht: 09. September 2021

Angenommen: 11. Februar 2022

Artikel online veröffentlicht:
27. Juni 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Levy B, Paulozzi L, Mack KA, Jones CM. Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012. Am J Prev Med 2015; 49 (03) 409-413
    CrossrefPubMedSuche in Google Scholar
  • 2 UNODC. World Drug Report. Published 2020. Updated 6/2020. Accessed September 13, 2020 at: https://wdr.unodc.org/wdr2020/field/WDR20_Booklet_2.pdf
    PubMed
  • 3 Hagemeier NE. Introduction to the opioid epidemic: the economic burden on the healthcare system and impact on quality of life. Am J Manag Care 2018; 24 (10, Suppl): S200-S206
    PubMedSuche in Google Scholar
  • 4 Gottschalk A, Berkow LC, Stevens RD. et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg 2007; 106 (02) 210-216
    CrossrefPubMedSuche in Google Scholar
  • 5 De Benedittis G, Lorenzetti A, Migliore M, Spagnoli D, Tiberio F, Villani RM. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery 1996; 38 (03) 466-469 , discussion 469–470
    PubMedSuche in Google Scholar
  • 6 Tsaousi GG, Logan SW, Bilotta F. Postoperative pain control following craniotomy: a systematic review of recent clinical literature. Pain Pract 2017; 17 (07) 968-981
    CrossrefPubMedSuche in Google Scholar
  • 7 Thibault M, Girard F, Moumdjian R, Chouinard P, Boudreault D, Ruel M. Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study. Can J Anaesth 2007; 54 (07) 544-548
    CrossrefPubMedSuche in Google Scholar
  • 8 Irefin SA, Schubert A, Bloomfield EL, DeBoer GE, Mascha EJ, Ebrahim ZY. The effect of craniotomy location on postoperative pain and nausea. J Anesth 2003; 17 (04) 227-231
    CrossrefPubMedSuche in Google Scholar
  • 9 Vadivelu N, Kai AM, Tran D, Kodumudi G, Legler A, Ayrian E. Options for perioperative pain management in neurosurgery. J Pain Res 2016; 9: 37-47
    CrossrefPubMedSuche in Google Scholar
  • 10 Badash I, Lui CG, Hur K, Acevedo JR, Ference EH, Wrobel BB. Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery. Laryngoscope 2020; 130 (05) 1122-1127
    CrossrefPubMedSuche in Google Scholar
  • 11 Mobini A, Mehra P, Chigurupati R. Postoperative pain and opioid analgesic requirements after orthognathic surgery. J Oral Maxillofac Surg 2018; 76 (11) 2285-2295
    CrossrefPubMedSuche in Google Scholar
  • 12 Stephenson ED, Farzal Z, Jowza M, Hackman T, Zanation A, Du E. Postoperative analgesic requirement and pain perceptions after nonaerodigestive head and neck surgery. Otolaryngol Head Neck Surg 2019; 161 (06) 970-977
    CrossrefPubMedSuche in Google Scholar
  • 13 Sanford Z, Broda A, Taylor H, Turcotte J, Patton CM. Predictive risk factors associated with increased opioid use among patients undergoing elective spine surgery. Int J Spine Surg 2020; 14 (02) 189-194
    CrossrefPubMedSuche in Google Scholar
  • 14 Bernstein JA, Feng J, Mahure SA, Schwarzkopf R, Long WJ. Revision total hip arthroplasty is associated with significantly higher opioid consumption as compared to primary total hip arthroplasty in the acute postoperative period. Hip Int 2020; 30 (1_suppl): 59-63
    CrossrefPubMedSuche in Google Scholar
  • 15 Roof MA, Sullivan CW, Feng JE. et al. Inpatient opioid consumption variability following total knee arthroplasty: analysis of 4,038 procedures. J Knee Surg 2021; 34 (11) 1196-1204
    Thieme ConnectPubMedSuche in Google Scholar
  • 16 Kim SC, Choudhry N, Franklin JM. et al. Patterns and predictors of persistent opioid use following hip or knee arthroplasty. Osteoarthritis Cartilage 2017; 25 (09) 1399-1406
    CrossrefPubMedSuche in Google Scholar
  • 17 Lavoie-Gagne O, Nwachukwu BU, Allen AA, Leroux T, Lu Y, Forsythe B. Factors predictive of prolonged postoperative narcotic usage following orthopaedic surgery. JBJS Rev 2020; 8 (06) e0154
    CrossrefPubMedSuche in Google Scholar
  • 18 Gill AS, Virani FR, Hwang JC. et al. Preoperative gabapentin administration and its impact on postoperative opioid requirement and pain in sinonasal surgery. Otolaryngol Head Neck Surg 2021; 164 (04) 889-894
    CrossrefPubMedSuche in Google Scholar
  • 19 Kelley NE, Tepper DE. Rescue therapy for acute migraine, part 3: opioids, NSAIDs, steroids, and post-discharge medications. Headache 2012; 52 (03) 467-482
    CrossrefPubMedSuche in Google Scholar
  • 20 Marmura MJ, Silberstein SD, Schwedt TJ. The acute treatment of migraine in adults: the American Headache Society evidence assessment of migraine pharmacotherapies. Headache 2015; 55 (01) 3-20
    CrossrefPubMedSuche in Google Scholar
  • 21 Mayans L, Walling A. Acute migraine headache: treatment strategies. Am Fam Physician 2018; 97 (04) 243-251
    PubMedSuche in Google Scholar
  • 22 Ong JJY, De Felice M. Migraine treatment: current acute medications and their potential mechanisms of action. Neurotherapeutics 2018; 15 (02) 274-290
    CrossrefPubMedSuche in Google Scholar
  • 23 Dodick DW. Migraine. Lancet 2018; 391 (10127): 1315-1330
    CrossrefPubMedSuche in Google Scholar
  • 24 Bourazani M, Papageorgiou E, Zarkadas G. et al. The role of muscle relaxants – spasmolytic (thiocochlicoside) in postoperative pain management after mastectomy and breast reconstruction. Asian Pac J Cancer Prev 2019; 20 (03) 743-749
    CrossrefPubMedSuche in Google Scholar
  • 25 Perera AP, Chari A, Kostusiak M, Khan AA, Luoma AM, Casey ATH. Intramuscular local anesthetic infiltration at closure for postoperative analgesia in lumbar spine surgery: a systematic review and meta-analysis. Spine 2017; 42 (14) 1088-1095
    CrossrefPubMedSuche in Google Scholar
  • 26 Suffeda A, Meissner W, Rosendahl J, Guntinas-Lichius O. Influence of depression, catastrophizing, anxiety, and resilience on postoperative pain at the first day after otolaryngological surgery: a prospective single center cohort observational study. Medicine (Baltimore) 2016; 95 (28) e4256
    CrossrefPubMedSuche in Google Scholar
  • 27 Goebel S, Baumann B, Steinert A, Reppenhagen S, Faller H. [Elevated postoperative pain levels following orthopedic surgery. Depression as a strong predictor]. Schmerz 2010; 24 (01) 54-61
    PubMedSuche in Google Scholar
  • 28 Theunissen M, Peters ML, Bruce J, Gramke HF, Marcus MA. Preoperative anxiety and catastrophizing: a systematic review and meta-analysis of the association with chronic postsurgical pain. Clin J Pain 2012; 28 (09) 819-841
    CrossrefPubMedSuche in Google Scholar
  • 29 Dadgostar A, Bigder M, Punjani N, Lozo S, Chahal V, Kavanagh A. Does preoperative depression predict post-operative surgical pain: a systematic review. Int J Surg 2017; 41: 162-173
    CrossrefPubMedSuche in Google Scholar
  • 30 Zeng M, Dong J, Lin N. et al. Preoperative gabapentin administration improves acute postoperative analgesia in patients undergoing craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol 2019; 31 (04) 392-398
    CrossrefPubMedSuche in Google Scholar
  • 31 Shepherd DM, Jahnke H, White WL, Little AS. Randomized, double-blinded, placebo-controlled trial comparing two multimodal opioid-minimizing pain management regimens following transsphenoidal surgery. J Neurosurg 2018; 128 (02) 444-451
    CrossrefPubMedSuche in Google Scholar
  • 32 Mont MA, Beaver WB, Dysart SH, Barrington JW, Del Gaizo DJ. Local infiltration analgesia with liposomal bupivacaine improves pain scores and reduces opioid use after total knee arthroplasty: results of a randomized controlled trial. J Arthroplasty 2018; 33 (01) 90-96
    CrossrefPubMedSuche in Google Scholar
  • 33 Song J, Li L, Yu P, Gao T, Liu K. Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine reduces postoperative pain after craniotomy. Acta Neurochir (Wien) 2015; 157 (06) 993-998
    CrossrefPubMedSuche in Google Scholar
  • 34 Greenberg S, Murphy GS, Avram MJ. et al. Postoperative intravenous acetaminophen for craniotomy patients: a randomized controlled trial. World Neurosurg 2018; 109: e554-e562
    CrossrefPubMedSuche in Google Scholar
  • 35 Southworth S, Peters J, Rock A, Pavliv L. A multicenter, randomized, double-blind, placebo-controlled trial of intravenous ibuprofen 400 and 800 mg every 6 hours in the management of postoperative pain. Clin Ther 2009; 31 (09) 1922-1935
    CrossrefPubMedSuche in Google Scholar
  • 36 Galvin IM, Levy R, Day AG, Gilron I. Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery. Cochrane Database Syst Rev 2019;2019(11):
    PubMed
  • 37 Song J, Ji Q, Sun Q, Gao T, Liu K, Li L. The opioid-sparing effect of intraoperative dexmedetomidine infusion after craniotomy. J Neurosurg Anesthesiol 2016; 28 (01) 14-20
    CrossrefPubMedSuche in Google Scholar
  • 38 Peng K, Jin XH, Liu SL, Ji FH. Effect of intraoperative dexmedetomidine on post-craniotomy pain. Clin Ther 2015; 37 (05) 1114-1121.e1 , e1111
    CrossrefPubMedSuche in Google Scholar