Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, USA.
School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Oper Neurosurg (Hagerstown). 2021 Jun 15;21(1):6-13. doi: 10.1093/ons/opab040.
Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use.
To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG).
Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests.
The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117).
Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.
微创手术 (MIS) 已被证明可缩短住院时间并减少阿片类药物的使用。
确定通过 MIS 立体定向放置脑电图 (SEEG) 电极进行癫痫手术与开颅放置脑电图网格 (ECoG) 相比是否会减少总体阿片类药物的使用。
通过回顾性病历审查，从 2015 年到 2018 年，确定了接受癫痫手术（SEEG 或 ECoG）的患者。住院时间分为特定时间段，以区分术后立即、整个住院期间和出院时的阿片类药物使用情况。通过将所有类型的阿片类药物转化为等效吗啡剂量 (ME)，计算每个时间段内消耗的阿片类药物总量。还使用临床对齐疼痛评估 (CAPA) 量表的修改版收集疼痛评分。使用适当的统计检验比较 2 个手术组。
该研究确定了 43 名符合纳入标准的患者：36 名接受了 SEEG 放置，17 名接受了开颅网格放置。在 ECoG 和 SEEG 放置组之间，住院期间每例患者的中位数阿片类药物消耗存在统计学显著差异，分别为 307.8 和 71.5 ME（P =.0011）。两组之间的 CAPA 量表也存在显著差异（P =.0117）。
与接受更具侵入性的 ECoG 手术的患者相比，通过 MIS 癫痫手术进行 SEEG 检查的患者的阿片类药物使用量明显较低。作为减少总体阿片类药物负担的一部分，在决定手术方法时，患者和外科医生应考虑这些结果。
