Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Area of Science:

• Neurosurgery
• Pain Management
• Public Health

Background:

• Opioid abuse is a significant public health concern.
• The perioperative period presents a risk for initial opioid exposure.
• Limited data exists on postoperative pain and opioid use following endoscopic skull base surgery (ESBS).

Purpose of the Study:

• To investigate postoperative pain and opioid consumption patterns in patients undergoing ESBS.
• To identify factors associated with increased opioid use and duration after ESBS.

Main Methods:

• A prospective, longitudinal cohort study was conducted at a single institution.
• Adult patients undergoing ESBS were enrolled between November 2019 and March 2020.
• Pain and opioid consumption were quantified via preoperative questionnaires and regular postoperative follow-up.

Main Results:

• Eighty-five percent of the 33 enrolled patients underwent ESBS for sellar pathology.
• History of headache disorder and preoperative opioid use were linked to greater opioid consumption (MME 381.9 ± 476.0).
• Headache disorder, depression, anxiety, younger age (≤46), and prior opioid use correlated with longer opioid use duration. Prescription of NSAIDs at discharge was associated with reduced outpatient opioid use.

Conclusions:

• Postoperative opioid use following ESBS is influenced by pre-existing headache disorders and prior opioid exposure.
• While opioid use generally decreases post-surgery, specific patient factors can lead to prolonged use.
• A significant percentage of patients retain unused opioids post-recovery, highlighting potential for diversion.