Variability in Intraoperative Opioid and Nonopioid Utilization During Intracranial Surgery: A Multicenter, Retrospective Cohort Study.

Autor:	Naik BI; Department of Anesthesiology, University of Virginia, Charlottesville, VA., Lele AV; Department of Anesthesiology University of Washington, WA., Sharma D; Department of Anesthesiology University of Washington, WA., Akkermans A; Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands., Vlisides PE; Department of Anesthesiology, University of Michigan, MI., Colquhoun DA; Department of Anesthesiology, University of Michigan, MI., Domino KB; Department of Anesthesiology University of Washington, WA., Tsang S; Department of Anesthesiology, University of Virginia, Charlottesville, VA., Sun E; Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, CA., Dunn LK; Department of Anesthesiology, University of Virginia, Charlottesville, VA.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgical anesthesiology [J Neurosurg Anesthesiol] 2024 Mar 28. Date of Electronic Publication: 2024 Mar 28.
DOI:	10.1097/ANA.0000000000000960
Abstrakt:	Background: Key goals during intracranial surgery are to facilitate rapid emergence and extubation for early neurologic evaluation. Longer-acting opioids are often avoided or administered at subtherapeutic doses due to their perceived risk of sedation and delayed emergence. However, inadequate analgesia and increased postoperative pain are common after intracranial surgery. In this multicenter study, we describe variability in opioid and nonopioid administration patterns in patients undergoing intracranial surgery. Methods: This was a multicenter, retrospective observational cohort study using the Multicenter Perioperative Outcomes Group database. Opioid and nonopioid practice patterns in 31,217 cases undergoing intracranial surgery across 11 institutions in the United States are described. Results: Across all 11 institutions, total median [interquartile range] oral morphine equivalents, normalized to weight and anesthesia duration was 0.17 (0.08 to 0.3) mg.kg.min-1. There was a 7-fold difference in oral morphine equivalents between the lowest (0.05 [0.02 to 0.13] mg.kg.min-1) and highest (0.36 [0.18 to 0.54] mg.kg.min-1) prescribing institutions. Patients undergoing supratentorial surgery had higher normalized oral morphine equivalents compared with those having infratentorial surgery [0.17 [0.08-0.31] vs. 0.15 [0.07-0.27] mg/kg/min-1; P<0.001); however, this difference is clinically small. Nonopioid analgesics were not administered in 20% to 96.8% of cases across institutions. Conclusion: This study found wide variability for both opioid and nonopioid utilization at an institutional level. Future work on practitioner-level opioid and nonopioid use and its impact on outcomes after intracranial surgery should be conducted. Competing Interests: A.V.L. reports salary support from LifeCenter Northwest. P.V. receives support from Blue Cross Blue Shield of Michigan. E.S. is supported by a grant from the National Institute on Drug Abuse (K08DA042314) and reports consulting fees unrelated to this work from Analysis Group, Inc. and Lucid Lane, LLC. D.A.C. is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number K08HL159327. D.A.C. declares research support from Merck & Co. paid to the University of Michigan, unrelated to the presented work in the financial section. B.I.N. is a JNA Editorial Board member. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The remaining authors have no conflicts of interest to declare. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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