Comparison of narcotic pain control between stereotactic electrocorticography and subdural grid implantation

Yu Chi Wang, Sanjeet S. Grewal, Anshit Goyal, Mohammed Ali Alvi, Gregory Worrell, Benjamin Brinkmann, Lily Wong-Kisiel, Jeffrey William Britton, W. Richard Marsh, David Burkholder, Eric Payne, Cheolsu Shin, Gregory Cascino, Brian N. Lundstrom, Min Hsien Wu, Jamie J. Van Gompel

Research output: Contribution to journalArticle

Abstract

Introduction: The choice of subdural grid (SDG) or stereoelectroencephalography (sEEG) for patients with epilepsy can be complex and in some cases overlap. Comparing postoperative pain and narcotics consumption with SDG or sEEG can help develop an intracranial monitoring strategy. Materials and methods: A retrospective study was performed for adult patients undergoing SDG or sEEG monitoring. Numeric Rating Scale (NRS) was used for pain assessment. Types and dosage of the opioids were calculated by converting into milligram morphine equivalents (MME). Narcotic consumption was analyzed at the following three time periods: I. the first 24 h of implantation; II. from the second postimplantation day to the day of explantation; and III. the days following electrode removal to discharge. Results: Forty-two patients who underwent SDG and 31 patients who underwent sEEG implantation were analyzed. After implantation, average NRS was 3.7 for SDG and 2.2 for sEEG (P < .001). After explantation, the NRS was 3.5 for SDG and 1.4 in sEEG (P < .001). Sixty percent of SDG patients and 13% of sEEG patients used more than one opioid in period III (P < .001). The SDG group had a significantly higher MME throughout the three periods compared with the sEEG group: period I: 448 (SDG) vs. 205 (sEEG) mg, P = .002; period II: 377 (SDG) vs. 102 (sEEG) mg, P < .001; and period III: 328 (SDG) vs. 75 (sEEG) mg; P = .002. Patients with the larger SDG implantation had the higher NRS (P = .03) and the higher MME at period I (P = .019). There was no correlation between the number of depth electrodes and pain control in patients with sEEG. Conclusions: Patients undergoing sEEG had significantly less pain and required fewer opiates compared with patients with SDG. These differences in perioperative pain may be a consideration when choosing between these two invasive monitoring options.

Original languageEnglish (US)
Article number106843
JournalEpilepsy and Behavior
Volume103
DOIs
StatePublished - Feb 2020

Keywords

  • Intracranial monitoring
  • Narcotic
  • Postoperative pain
  • Stereoelectroencephalography
  • Subdural grid

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Behavioral Neuroscience

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    Wang, Y. C., Grewal, S. S., Goyal, A., Alvi, M. A., Worrell, G., Brinkmann, B., Wong-Kisiel, L., Britton, J. W., Marsh, W. R., Burkholder, D., Payne, E., Shin, C., Cascino, G., Lundstrom, B. N., Wu, M. H., & Van Gompel, J. J. (2020). Comparison of narcotic pain control between stereotactic electrocorticography and subdural grid implantation. Epilepsy and Behavior, 103, [106843]. https://doi.org/10.1016/j.yebeh.2019.106843