Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

Abstract

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

Postoperative protocols following endoscopic skull base surgery: An evidence‐based review with recommendations

“…In a recent retrospective study, Wu et al. suggested that active smokers and patients with grade 3 intraoperative CSF leaks were also associated with higher opiate use, requiring an additional 37.1 morphine milligram equivalents (MME) and 36.7 MME, respectively, in their first postoperative day 20 . Only one of these studies, however, examined how well patients’ pain was controlled, and none assessed whether some opioid‐naive patients’ pain may be overtreated with opioids.…”

Science and Research March Onward

“…Wu et al performed a retrospective review of 144 patients undergoing endoscopic endonasal transsphenoidal surgery, concluding that although opiate needs were higher compared to those undergoing endoscopic sinus surgery, the overall requirements were still low. 12 Independent risk factors associated with higher opiate use in the immediate postoperative period included smokers and grade 3 intraoperative cerebrospinal fluid leaks. Keeping in the realm of endoscopic skull base surgery, Xie and colleagues performed a systematic review in order to determine the accuracy of various tests for the diagnosis and localization of CSF rhinorrhea.…”