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Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter,
Bhiken I Naik1, Abhijit V Lele2, Deepak Sharma2
1Department of Anesthesiology, University of Virginia, Charlottesville, VA.
Journal of Neurosurgical Anesthesiology
|March 28, 2024
Summary
Opioid and nonopioid pain management varies widely after intracranial surgery across US institutions. This variability impacts patient care and necessitates further investigation into practitioner-level prescribing patterns.
Area of Science:
- Neuroanesthesia
- Surgical Pain Management
- Pharmacology
Background:
- Rapid emergence and extubation are key goals in intracranial surgery.
- Longer-acting opioids are often avoided due to concerns about delayed emergence.
- Inadequate analgesia and postoperative pain are common challenges.
Purpose of the Study:
- To describe institutional variability in opioid and nonopioid administration for intracranial surgery.
- To identify patterns in analgesic prescribing across different US institutions.
Main Methods:
- Multicenter, retrospective observational cohort study.
- Utilized the Multicenter Perioperative Outcomes Group database.
- Analyzed data from 31,217 intracranial surgery cases across 11 US institutions.
Main Results:
- Significant 7-fold institutional variability in opioid administration (0.05 to 0.36 mg.kg.min -1 oral morphine equivalents).
- Nonopioid analgesics were underutilized, ranging from 20% to 96.8% of cases.
- Supratentorial surgery cases received slightly higher opioid doses than infratentorial cases.
Conclusions:
- Wide institutional variability exists in both opioid and nonopioid analgesic use.
- Further research is needed at the practitioner level to understand the impact on outcomes.
- Optimizing multimodal analgesia strategies is crucial for improved patient recovery.
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