Postoperative Pain Management and Perceived Patient Outcomes following Endoscopic Pituitary Surgery

Purpose: Pain management has emerged as a point of emphasis in recent years given the ongoing opioid crisis in the United States. To date, there are no studies in the literature evaluating prescribing patterns and utilization of postoperative pain medication following endoscopic pituitary surgery. The goal of this study is to determine provider prescribing tendency, patient usage of pain medications, and perceived patient outcome regarding postoperative pain management. Such data will guide future prescribing methodologies and provide data for thoughtful prospective studies.

Methods: A total of 100 patients undergoing endoscopic pituitary surgery at one institution from 2016 to 2018 were identified. Postoperative pain medication regimens were obtained and patients were queried on the state narcotic database to determine if their narcotic prescription was filled. Patients were contacted via phone interview to determine the utilization and perceived outcome of their pain management regimen.

Results: A total of 54 different pain control regimens were prescribed to the 100 study patients. Also, 92% of study patients were prescribed an opioid upon discharge from the hospital and 85.9% of those patients filled the prescription. The average quantity of opioids prescribed per patient was 636 morphine milligram equivalents (MME), or the equivalent of 85 5 mg oxycodone tablets, with a standard deviation of 580 MME (equivalent to 77 5 mg oxycodone tablets) and a range of 30 to 4,200 MME (equivalent to 4–560 5 mg oxycodone tablets). But 44% of study patients participated in a subsequent telephone survey. Again, 93.2% of surveyed patients received an opioid prescription of whom 87.8% filled that prescription. While 83.3% of the patients who filled their opioid prescription reported utilization of the opioids, 70% of users reported using less than 25% of their total prescription. Among them, 60% of survey responders who utilized their opioid prescription reported that the majority of their use was within the first 24 to 48 hours following surgery. Also, 83.3% of surveyed patients who utilized prescription opioids found that the narcotic adequately controlled pain and aided in recovery while 100% of surveyed patients who used either alternative prescription analgesics or over-the-counter agents reported adequate pain control and aided recovery.

Conclusion: There is significant variability in the prescribing patterns of analgesic medication type, dose, and quantity even within a single institution following endoscopic pituitary surgery. Though opioid prescriptions in our patient population are typically filled and consumed in some capacity, patients who used their prescription opioids were nearly three times more likely to use less than 25% of their total regimen than they were to use the entire prescription. The substantial variability in postoperative pain management prescribing patterns and likely overprescribing of opioids in this patient population warrant further investigation into the topic of analgesic decision making in patients undergoing endoscopic pituitary surgery everywhere.