Subcutaneous sumatriptan: association with decreases in postoperative pain and opioid use after elective cranial surgery

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Sumatriptan, a serotonin receptor agonist, has been used in the management of primary headache disorders and has been shown to affect trigeminal dural afferents. There is limited literature on the safety and efficacy of sumatriptan for postcraniotomy pain management. This study aimed to identify whether subcutaneous sumatriptan is a safe and efficacious pain management strategy after elective craniotomy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors retrospectively reviewed patients who underwent supratentorial or suboccipital craniotomy between 2016 and 2019 that was performed by a single provider at a single institution to identify patients given subcutaneous sumatriptan in the postoperative period. Pain scores and intravenous and oral opioid use were compared in patients with (n = 15) and without (n = 45) sumatriptan administration.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Patients with and without sumatriptan administration had no significant differences in baseline characteristics or surgery type. There were no sumatriptan-related complications. The average pain score decreased from 3.9 to 1.3 within 1 hour after sumatriptan administration (p = 0.014). In both adult and pediatric patients there was decreased postoperative pain (adults: pain score of 1.1 vs 7.1, p &lt; 0.001; pediatric: 1.1 vs 3.9, p = 0.007) within the first 48 hours. There were decreases in intravenous opioid use, length of intravenous opioid use, maximum dose of intravenous opioid used, oral opioid use, length of oral opioid use, and maximum dose of oral opioid used in both adult and pediatric patients.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The authors identified subcutaneous sumatriptan as a safe and efficacious tool for postoperative pain management after craniotomy. Large multicenter randomized controlled studies are needed to further evaluate the specific role of sumatriptan in postoperative pain management after craniotomy.</jats:p></jats:sec>

Opioid Prescribing Patterns Following Lateral Skull Base Spontaneous Cerebrospinal Fluid Leak Repair

“…Patel et al (25) found that 2.3% of patients hospitalized for headaches had previously abused opioids, and opioid abusers with headaches have a higher prevalence of prolonged hospitalization, severe loss of function, and disability. These findings warrant careful opioid prescribing practices for patients with a history of headache and consideration of beneficial alternative or supplementary options like subcutaneous sumatriptan (26).…”

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2021

“…8 In this single-center, retrospective study on 60 patients who had a supratentorial or suboccipital craniotomy, Patel et al compared the postoperative pain scores and opioid use amongst patients who received 6 mg of subcutaneous sumatriptan ( n = 15) and those who did not ( n = 45). 9 Patients who received sumatriptan had significantly decreased average pain score at 1 hour compared with those who did not (1.3 vs. 3.9). These statistically significant differences between the groups remained constant for the first 24 hours in both adults (1.1 vs. 7.1) and pediatric patients (1.1 to 3.9).…”

Headache Management in Individuals with Brain Tumor

“…In the post-craniotomy patient, headache may affect both neurosurgical recovery and quality of life. 60 69 70 Fifty to 90% of individuals may require medication for pain relief post-craniotomy, 60 however headache often is undertreated. 63 69 This may be related in part to a dearth of evidence and consensus regarding treatment for post-operative pain following cranial neurosurgery.…”

“…Subcutaneous injection of sumatriptan, a medication used commonly as an abortive treatment for migraine, has been shown to be beneficial in a small study of individuals with post-craniotomy headache following microvascular decompression 71 ; in another study, subcutaneous sumatriptan was associated with decreased opioid use in both adult and pediatric populations following cranial surgery. 70 Other treatments used in the acute, post-surgical setting include gabapentin and regional anesthetic nerve blocks. 64,72,73 Though acetaminophen, NSAIDs, triptans, and opioids typically are used in moderation in the short-term postsurgically, certain risks should be considered.…”