Patterns of Opioid Usage and Predictors of Utilization Following Endoscopic Skull Base Surgery

Objective Pain control is an important topic that has not been extensively studied in patients undergoing endoscopic skull base surgery (ESBS). The purpose of this study is to identify opioid requirements after ESBS and the risk factors predictive of increased use. Methods This study was a retrospective review of all patients undergoing ESBS at a tertiary academic skull base surgery program between July 2018 and August 2020. The primary outcome variable was total morphine equivalent dose (MED) requirements after surgery, calculated as the sum of all morphine milligram equivalents over a 24-h period, and summated across the duration of each participant's hospital course. Results 94 patients were included in this review. Average daily MED requirements were 14.00 +/- 6.79 mg. Average total MED requirements were 83.78 +/- 92.99 mg during hospitalization. Average length of stay (LOS) was 5.71 +/- 4.42 days, with 22 (23.4%) patients not requiring opioid use upon discharge. On multivariate analysis, female sex (beta = 49.62; 95% CI [13.53, 85.71], p = 0.008), nasoseptal flap (NSF) reconstruction (beta = 49.56; 95% CI [13.51, 85.61], p = 0.008) and LOS (beta = 4.02; 95% CI [0.001, 8.04], p = 0.050) were independently associated with higher total MED requirements. Conclusions We report average total MED requirements of 83.78 mg after ESBS, with female sex, intraoperative use of an NSF, and increased LOS as predictors of higher MED use. This data indicates a subset of patients who may benefit from more aggressive pain control strategies upfront, including consideration of non-opioid, multimodal pain regimens. Level of Evidence 3 Laryngoscope, 2022