Efficacy of an opioid-sparing analgesic protocol in pain control after less invasive cranial neurosurgery

Abstract

Introduction: Opioid overuse in postoperative patients is a worrisome trend, and potential alternatives exist which warrant investigation. Nonsteroidal anti-inflammatory drug use in treating postoperative cranial surgery pain has been hampered by concern for inadequate pain control and increased risk of hemorrhagic complications. A safe and effective alternative to opioid-based pain management is critical to improving postoperative care. Objective: The objective of this retrospective study was to determine whether an NSAID-based opioid-sparing pain management protocol (OSP) is effective in analgesic control of less invasive cranial surgery patients at 6-, 12-, and 24-hour postoperatively. Secondary aims included investigating differences in hemorrhagic complications. Methods: Five hundred sixty-six consecutive patients who underwent cranial surgery before and after implementation of the celecoxib-based OSP were eligible. Propensity score matching was used to match patients in each cohort. Results: The opioid-sparing cohort had lower pain scores at 6 hours (3.45 vs 4.19, P 5 0.036), 12 hours (3.21 vs 4.00, P 5 0.006), and 24 hours (2.90 vs 3.59, P 5 0.010). Rates of postoperative hemorrhage were not significantly different (5% intervention vs 8% control, P 5 0.527). The opioid-sparing pain management protocol provided comparable or better pain control in the first 24 hours after less invasive cranial surgery. Hemorrhage rates did not change with the use of an NSAID-based OSP. Conclusion: An effective alternative to the current standard opioid-based pain management is feasible for less invasive cranial surgery. Determinations of hemorrhage risk and more complex cranial surgery will require larger prospective randomized trials.

Efficacy of Cyclooxygenase-2 Inhibitors for Headache in Acute Brain Injury: A Systematic Review

“…The initial search yielded a total of 3190 articles. Following the removal of duplicates, 2988 articles were screened, with 6 studies meeting eligibility criteria (Figure 1): four RCT [27][28][29][30] and two retrospective cohort studies [31,32]. All studies were conducted in neurosurgical patients (n=738), between 2006-2022.…”

“…Five studies assessed the e cacy of COXIBs for headache control in the intervention versus control groups [27,28,[30][31][32], and one study assessed two different pain regimens employing COXIBs, in both the intervention and control groups [29]. The speci c COXIBs used, dosing, frequency, timing, and routes of administration varied; parecoxib 40 mg IV was most frequently employed (n=264) [27,[29][30][31], followed by celecoxib (n=93) [32] and rofecoxib (n=14) [28]. Pain scores were reported as mean or median at different time points, from the immediate postoperative period (0 hours) up to 72 hours.…”

“…In all studies, pain scores ranged between mild and moderate severity. Four studies noted decreased pain scores at overall time points for the intervention groups compared with control groups [28, 29,31,32], while one study only did so at one point in time (6 hours postoperative) [27]. Overall, pain scores dropped between 4-15%, with the largest shift observed from moderate to mild severity.…”

“…Three studies found a decrease in opioid use throughout the hospital course for the intervention groups [28, 29,32], whereas one study noted a reduction only at 12 hours postoperative [27]. Overall, opioid consumption decreased by 9-90%.…”

The Prevalence and Factors Associated with the Prescription of Opioids for Head/Neck Pain after Elective Craniotomy for Tumor Resection/Vascular Repair: A Retrospective Cohort Study

“…At this time, opioid-free craniotomy care remains elusive [ 21 , 29 , 30 ], yet aspirational. To achieve an opioid-free state, there needs to be a shared mental model of understanding between the patient, the anesthesiologist, the neurosurgeon, and all postoperative clinicians.…”