Opiate Use After Endoscopic Endonasal Transsphenoidal Surgery

Background The literature on opiate use after endoscopic endonasal transsphenoidal surgery (EETS) is limited. Objective To determine the risk factors for higher opiate use following EETS and the quantity of opiates used after discharge. Methods A retrospective review of 144 patients undergoing EETS from July 2018 to July 2020 was conducted. Patient, tumor, and surgical factors were documented. Pain scores and medications used on postoperative days (POD) 0 and 1, and discharge prescriptions, were recorded. Opiate use was quantified using morphine milligram equivalents (MME) dose. Multiple linear regression determined risk factors independently associated with POD0 to 1 opiate use. Results On POD 0 to 1, mean pain score was 4.9/10 (standard deviation [SD] ± 2.0). Mean acetaminophen use was 3.4 tablets (SD ± 1.6; 650 mg per tablet). Mean opiate use was 35.6 MME (SD ± 36.3), equivalent to 4.7 tablets (SD ± 4.8) of oxycodone 5 mg. Multiple linear regression showed that current smokers required an additional 37.1 MME ( P = .011), and patients with grade 3 intraoperative cerebrospinal fluid leaks required an additional 36.7 MME ( P = .046) on POD0 to 1. On discharge, mean opiate prescription was 117.7 MME (SD ± 102.1), equivalent to 15.7 tablets (SD ± 13.6) of oxycodone 5 mg. Thirty-nine patients (27.1%) did not require prescriptions. Only 10 patients (6.9%) required opiate refill(s) within 30 days after surgery. Conclusion Patients undergoing EETS have higher opiate needs compared to those undergoing endoscopic sinus surgery, although the overall requirements are still considered low. Independent risk factors associated with higher opiate use in the immediate postoperative period included current smokers and grade 3 intraoperative cerebrospinal fluid leaks.

The association of postoperative dexmedetomidine with pain, opiate utilization, and hospital length of stay in children post–Chiari malformation decompression

OBJECTIVE The aim of this study was to determine the association of postoperative dexmedetomidine with markers of pain in children undergoing Chiari malformation decompression. The authors hypothesized that patients receiving dexmedetomidine postoperatively would have decreased cumulative opiate use. They further hypothesized that there would be no difference in median pain scores, outcomes, or medication adverse events. METHODS An IRB-approved retrospective cohort study of patients undergoing Chiari malformation decompression from December 1, 2015, to December 31, 2018, was performed. Patients aged 0–21 years who underwent intradural Chiari malformation decompression at a single institution were included. Data for those who used dexmedetomidine postoperatively were compared with those who did not use dexmedetomidine. The primary outcome was cumulative opiate use throughout hospitalization. Secondary outcomes included pain scores, ancillary medication use, adverse events, hospital and ICU length of stay, readmission rates, and hospital cost. RESULTS The authors reviewed the records of 172 patients who underwent Chiari malformation decompression. Of those patients, 86 received dexmedetomidine postoperatively and 86 did not. Demographics were not different between the groups. Patients who received dexmedetomidine postoperatively received more doses of dexamethasone and were also more frequently exposed to dexmedetomidine intraoperatively (p = 0.028). Patients who received dexmedetomidine postoperatively used fewer morphine equivalents during their admission (1.02 mg/kg vs 1.43 mg/kg, p = 0.003). The patients who received dexmedetomidine postoperatively also had lower median pain scores on postoperative day 0 (0 vs 2, p < 0.001), lower median pain scores throughout the entire admission (1 vs 2, p < 0.001), and lower maximum pain scores recorded (6 vs 8, p = 0.005). Adjusting for steroid dose number and intraoperative dexmedetomidine exposure, postoperative dexmedetomidine remained associated with lower opiate dosing, lower pain scores on postoperative day 0, lower scores throughout hospital stay, and lower maximum pain scores. Patients who received dexmedetomidine had shorter hospital lengths of stay by 19 hours (p < 0.001). There were no statistically significant differences in medication adverse events or hospital costs between the two groups. CONCLUSIONS Postoperative dexmedetomidine use was associated with decreased opiate use, lower pain scores, and shorter hospital length of stay in this cohort. Dexmedetomidine may be considered as a safe adjuvant medication that may have opiate-sparing effects for this patient population.

Assessment of the Effectiveness of Matrix Model Among Methadone Patients Using ATS in Ho Chi Minh City, Vietnam

This study assessed the effectiveness of the application of the Matrix model in patients undergoing methadone treatment for Amphetamine-type substance (ATS) in Ho Chi Minh City. A total of 951 methadone patients were screened; 60 (16%) met the inclusion criteria and of those 51 (85%) completed 16 weeks of study procedures. Most of the participants were ATS users with moderate or higher risk of dependence. Compared to the non-intervention group, the intervention group showed a significant reduction in positive urine tests for methamphetamine (a decrease from 100% to 11% vs. a decrease from 100% to 98% for the non-intervention group, p<0.001) and for opiates (a decrease from 36.7% to 3.7% vs. a decrease from 43.3% to 29.2% for the non-intervention group). In the intervention group, the quality of life increased from 76.74 points to 85.5, the proportion of depression decreased from 43.3% to 18.5%, anxiety decreased from 30% to 11.1%, and stress decreased from 76.7% to 29.6%. In the non-intervention group, quality of life decreased from 75.2 points to 74.5 points, the proportion of depression decreased slightly from 40% to 36%, anxiety decreased from 33.3% to 24%, and stress decreased from 76.7% to 76.0%. The intervention group was significantly more likely to adhere to methadone treatment (p<0.001). The proportions of participants in the intervention group and non-intervention group who discontinued treatment were 10% and 20%, respectively. The study results suggested that the MATRIX model could help reduce ATS and opiate use and improve mental health as well as treatment adherence.