Opioid-Free Anesthesia for Craniotomy

Abstract

Background: Perioperative opioids are problematic following craniotomy as they can impede neurological examination because of excessive sedation and mask surgical complications. Multimodal anesthetic techniques including nerve blocks have been used successfully to deliver opioid-free anesthesia in other surgical populations; however, no clinical data evaluating opioid-free anesthesia for craniotomy exists within the current body of literature.Materials and Methods: Six prospectively identified patients underwent supratentorial craniotomy at Emory University Hospital using a multimodal opioid-free anesthetic (OFA) technique consisting of preoperative scalp block, dexmedetomidine and intravenous acetaminophen. These opioid-free patients were matched by age, sex, incision length, and incision location to 18 retrospectively identified control patients who underwent craniotomy using conventional, opioid-based anesthetic techniques. Postoperative opioid consumption and pain scores were compared and analyzed for noninferiority.Results: Noninferiority of the OFA technique was demonstrated for opioid consumption at all measured intervals from postanesthesia care unit arrival to 24 hours postoperatively. Noninferiority was also demonstrated with respect to average postoperative pain scores from 0 to 12 hours, 0 to 24 hours, as well as length of postanesthesia care unit stay. Noninferiority was not shown for time to first rescue opioid postoperatively, pain scores for the 12 to 24 hours postoperative period, or time to emergence from anesthesia.Conclusions: This pilot study demonstrates the feasibility of an OFA technique for patients undergoing supratentorial craniotomy and suggests that larger prospective randomized controlled trials are indicated to examine the role of multimodal anesthetic techniques for craniotomy.

Paciente neuroquirúrgico perioperatorio: caracterización demográfica, clínica y factores asociados a eventos adversos

“…Por otra parte, este estudio permitió describir los diferentes fármacos utilizados para la inducción anestésica, lo que no se había realizado en otros estudios y nos permite conocer la práctica en nuestro medio, en donde encontramos que en casi todos los pacientes se utilizó un opioide, que en la mayoría de los casos correspondió al fentanilo y el mantenimiento se realizó principalmente con sevorane + remifentanilo. Teniendo en cuenta que el uso de opioides perioperatorios, en el entorno de pacientes llevados a craneotomía, pueden impedir el examen neurológico debido a la sedación excesiva y enmascarar las complicaciones quirúrgicas, una publicación reciente demostró la no inferioridad de la técnica anestésica libre de opioides para el consumo de opioides desde la llegada a la unidad de cuidados posanestésicos hasta las 24 h posteriores a la cirugía, y con respecto a las puntuaciones promedio de dolor posoperatorio de 0 a 24 h [10].…”

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

“…Our study finds that opioid use is common in the postoperative period [ 23 ]. While in a small sample study, opioid-free craniotomy [ 24 ] was found to be non-inferior to traditional pain control concerning pain scores in the postoperative period, opioid-free post-craniotomy pain management remains elusive and warrants further examination. Only a minority of patients remained “opioid-free” during their hospital stay, given the “severe” pain cited by a substantial proportion of patients during their post-craniotomy period.…”