Institutional Trends in Post-Craniotomy Opioid Usage

Introduction: Opioids are commonly used post-craniotomy to provide analgesia. Currently, there is little evidence guiding prescribing practices. With the rise of opioid-related addiction and deaths in recent years, physicians must take more responsibility in minimizing opioid over-prescribing to mitigate this ongoing health care crisis. This study aimed to characterize our institutional opioid use post-craniotomy and correlate opioid use with patients’ pain experience.

Methods: We retrospectively analyzed charts of all patients who underwent craniotomies for any indication from February 2020 to September 2021. Patients who had extended hospital stays post operatively (>10 days) or who could not communicate with nurses were excluded from the study. We collected daily post-operative pain scores (range: 0-10) and compared pain ratings to daily administered morphine milligram equivalents (MME). Additionally, we analyzed opioid prescribing practices at discharge.

Results: In 252 patients, pain ratings were highest on post-operative day (POD) zero (2.26 ± 3.10) and POD2 (1.64 ± 2.36). Post-operatively, 75% (n = 189) of patients received opioids. Average daily MME was highest on POD0 (67.56 ± 121.25) but decreased throughout the admission. At time of discharge, 48.01% (n = 121) of patients were prescribed opioids (MME: 42.25 ± 55.15). Many patients who reported no pain at discharge (n = 164, 65.1%) were prescribed opioids (n = 65, 39.6%), while few requested additional pain medications after discharge (n = 12, 7.31%). Of the patients who were prescribed opioids at discharge (n = 121, 48.01%), few (n = 12, 9.99%) requested additional pain medication. Patients who were given opioids on POD1 were more likely to request additional pain medication (13.76% vs 1.58%, p = 0.004).

Conclusion : Despite low pain ratings after craniotomy, opioids are commonly prescribed post-operatively and at discharge. Targeting the inconsistencies between patients’ reported pain and opioid prescribing may limit superfluous prescribing and improve the current crisis.