Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery.

Area of Science:

• Neurosurgery
• Pain Management
• Ophthalmology

Background:

• Limited data exists on opiate consumption following endoscopic endonasal transsphenoidal surgery (EETS).
• Understanding postoperative pain management is crucial for patient recovery after EETS.

Purpose of the Study:

• To identify risk factors associated with increased opiate use post-EETS.
• To quantify the amount of opiates prescribed and used after patient discharge.

Main Methods:

• Retrospective review of 144 patients undergoing EETS between July 2018 and July 2020.
• Analysis of patient, tumor, and surgical factors, alongside pain scores and medication use (POD 0-1 and discharge).
• Quantification of opiate use in morphine milligram equivalents (MME) with multivariable regression for risk factor identification.

Main Results:

• Mean opiate use on postoperative days 0-1 was 35.6 MME.
• Current smokers (37.1 MME increase) and grade 3 CSF leaks (36.7 MME increase) were independent risk factors for higher immediate postoperative opiate use.
• Mean discharge opiate prescription was 117.7 MME, with 27.1% of patients not requiring any prescription and only 6.9% needing refills within 30 days.

Conclusions:

• While overall opiate requirements post-EETS are low, they are higher than after endoscopic sinus surgery.
• Current smoking status and intraoperative cerebrospinal fluid leaks are key predictors of increased immediate postoperative opiate demand.
• Targeted pain management strategies can be developed based on identified risk factors.