TY - JOUR
T1 - Reduced Pain and Opioid Use in the Early Postoperative Period in Patients Undergoing a Frontotemporal Craniotomy under Regional vs General Anesthesia
AU - Bojaxhi, Elird
AU - Louie, Christopher
AU - ReFaey, Karim
AU - Gruenbaum, Shaun E.
AU - Leone, Bruce J.
AU - Bechtel, Perry
AU - Barbosa, Maria P.
AU - Chaichana, Kaisorn L.
AU - Quinones-Hinojosa, Alfredo
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2021/6
Y1 - 2021/6
N2 - Introduction: This study compares the postsurgical course of frontotemporal craniotomies conducted “awake” under regional anesthesia (RA) versus “asleep” under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. Methods: We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded. Primary outcomes included pain scores on a 0–10 numerical rating scale, opioid use as oral morphine milligram equivalence, first time to opioid use, nausea, and sedation on the Richmond Agitation and Sedation Scale (RASS). Secondary outcomes included postoperative seizures, Karnofsky Performance Scale (KPS) status, and hospital length of stay (LOS). Results: A total of 91 patients met inclusion criteria: 56 underwent a craniotomy under RA versus 35 under GA. Demographics and operative characteristics were similar between cohorts. A significant reduction in both postoperative pain and opioid use was observed among RA versus GA (first postoperative pain score 2 vs. 5, P < 0.01; postoperative day [POD] 0 median pain score 2.5 vs. 4, P < 0.01; POD 0 mean opioid in mg 14.49 vs. 24.43, P < 0.01). The time until patients requested opioids for pain after surgery was prolonged for RA versus GA [mean 7.23 vs. 3.42 hours, P < 0.01). Somnolence (RASS < 0) on POD 0 was significantly reduced among RA versus GA, with 23% versus 43%. Both cohorts had equivocal postsurgical outcomes such as seizures, KPS, and hospital LOS. Conclusions: Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.
AB - Introduction: This study compares the postsurgical course of frontotemporal craniotomies conducted “awake” under regional anesthesia (RA) versus “asleep” under general anesthesia (GA) to investigate postoperative recovery, pain, opioid use, and anesthesia-related side effects. Methods: We retrospectively reviewed craniotomies for supratentorial, intra-axial tumors with frontotemporal exposure. Chronic opioid use and emergent cases were excluded. Primary outcomes included pain scores on a 0–10 numerical rating scale, opioid use as oral morphine milligram equivalence, first time to opioid use, nausea, and sedation on the Richmond Agitation and Sedation Scale (RASS). Secondary outcomes included postoperative seizures, Karnofsky Performance Scale (KPS) status, and hospital length of stay (LOS). Results: A total of 91 patients met inclusion criteria: 56 underwent a craniotomy under RA versus 35 under GA. Demographics and operative characteristics were similar between cohorts. A significant reduction in both postoperative pain and opioid use was observed among RA versus GA (first postoperative pain score 2 vs. 5, P < 0.01; postoperative day [POD] 0 median pain score 2.5 vs. 4, P < 0.01; POD 0 mean opioid in mg 14.49 vs. 24.43, P < 0.01). The time until patients requested opioids for pain after surgery was prolonged for RA versus GA [mean 7.23 vs. 3.42 hours, P < 0.01). Somnolence (RASS < 0) on POD 0 was significantly reduced among RA versus GA, with 23% versus 43%. Both cohorts had equivocal postsurgical outcomes such as seizures, KPS, and hospital LOS. Conclusions: Frontotemporal craniotomy under RA during awake craniotomies provides better pain control, a reduction in opioid use, and less somnolence in the early postoperative period.
KW - Awake craniotomy
KW - Postoperative pain
KW - Regional anesthesia
KW - Scalp block
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U2 - 10.1016/j.wneu.2021.02.009
DO - 10.1016/j.wneu.2021.02.009
M3 - Article
C2 - 33684585
AN - SCOPUS:85103310382
SN - 1878-8750
VL - 150
SP - e31-e37
JO - World neurosurgery
JF - World neurosurgery
ER -