JoVE - Journal of Visualized Experiments
JoVE Visualize
Contact Us

Analgesia After Vestibular Schwannoma Surgery in Europe-Potential for Reduction of Postoperative Opioid Usage

  • 0Department of Otorhinolaryngology.
Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology +

|

December 12, 2024

|

December 12, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Opioid use after vestibular schwannoma surgery is common but often short-term. Non-opioid strategies can effectively manage long-term pain, reducing opioid reliance and associated health risks.

Area Of Science

  • Neurosurgery
  • Pain Management
  • Public Health

Background

  • Opioid overprescription contributes to chronic drug abuse and public health crises.
  • Vestibular schwannoma (VS) surgery requires effective postoperative pain management.
  • Minimizing opioid use is crucial in the context of the ongoing opioid epidemic.

Purpose Of The Study

  • To analyze analgesic prescription patterns after VS surgery, focusing on opioid rates.
  • To identify predictors for receiving postoperative opioid analgesia.
  • To assess the feasibility of opioid-free pain management strategies post-VS surgery.

Main Methods

  • Retrospective chart review of 105 adult patients undergoing VS surgery at a tertiary referral center.
  • Evaluation of analgesic prescription data, including non-opioid and opioid medications.
  • Statistical analysis to identify risk factors associated with opioid prescription.

Main Results

  • Metamizole and acetaminophen were the most frequent non-opioid analgesics prescribed.
  • 60% of patients received opioids, with most (90.5%) using them only beyond postoperative day 1.
  • Middle cranial fossa tumor removal was associated with higher opioid use, while retrosigmoid craniotomy correlated with lower opioid requirements.

Conclusions

  • While opioids may be necessary for acute pain post-VS surgery, non-opioid regimens are effective for middle- and long-term pain control.
  • Implementing non-opioid strategies can significantly reduce opioid prescriptions.
  • Reducing opioid use mitigates negative impacts on individual and public health, addressing the opioid epidemic.

Related Concept Videos

Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy 01:26

49

Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...

Analgesia and Pain Management 01:25

504

Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...

Opioid Analgesics: Synthetic and Semisynthetic Opioids 01:15

223

Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...

General Anesthesia: Overview 01:24

192

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...

Local Anesthetics: Clinical Application as Spinal Anesthesia 01:11

582

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...