Medical Student Mayo Clinic Alix School of Medicine
Introduction: Poor pain control has a negative impact on postoperative recovery and patient satisfaction. However, overzealous pain management with opioids can confound serial neurological assessments, increase morbidity, and predispose patients to long-term dependence. Nonsteroidal antiinflammatory drugs (NSAIDs) are effective in treating postoperative pain, but their use has been limited in patients undergoing craniotomy for tumor resection due to hemorrhagic concerns.
Methods: Retrospective cohort study of patients ≥18-years-old who underwent craniotomy for tumor resection at a single-center between 2019-2021. Exclusion criteria: baseline GFR was < 60 ml/min/BSA, non-craniotomy procedure, intraoperative hemorrhage, or intubated for >24 hours postoperatively. NSAID use 48-hours postoperatively was recorded. Primary outcomes were postoperative hemorrhage requiring return to the OR for decompression and/or evacuation prior to hospital discharge and within 30-days of surgery.
Results: 600 patients were included, 52 patients received ≥1 dose of an NSAID within 48-hours of their craniotomy. 2 patients returned to the OR before hospital discharge and 3 patients returned to the OR within 30-days of surgery for hematoma evacuation. None of the patients meeting the primary endpoint received perioperative NSAIDs. Comparatively, 25 non-NSAID patients (4.6%) were found to have subclinical-hemorrhage within 30-days of surgery compared to 4 patients(7.7%) treated with NSAIDs. In the non-NSAID group, 2 patients (0.4%) experienced post-operative acute kidney injury and 1 patient (0.2%) had significant extracranial bleeding; 0 patients treated with NSAIDs had acute kidney injury or non-intracranial bleeding. The median oral morphine equivalents used within 48-hours of surgery was 37.5 for non-NSAID group and 67.5 for the NSAID group.
Conclusion : Postoperative NSAID use following craniotomy for tumor resection was not associated with increased risk of hemorrhage requiring a return to the OR. Unexpectedly, we noted higher opioid use in patients treated with NSAIDs. These data warrant further investigation as a safe, non-opioid post-operative pain management strategy in patients undergoing intracranial tumor resection.
