302 Significant Reduction in Opioid Use Following Craniotomy Through a Comprehensive, Generalizable Multi-Modal Recovery Protocol: A Single-Institution Cohort Study

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INTRODUCTION: Effective post-craniotomy pain management remains challenging. Despite efforts, no intervention has substantially reduced narcotic requirements in this population. We present the outcomes of a multimodal pain management protocol aimed at minimizing opioid use following craniotomy. METHODS: We conducted a prospective cohort analysis comparing post-operative opioid utilization throughout hospitalization in patients undergoing elective, urgent and emergent craniotomies at a single institution by a single surgeon. Patients in the historical cohort (September 2017–December 2018) received the traditional analgesia algorithm. the protocol (including pre-operative counseling, total-Intravenous-anesthesia (TIVA), multimodal opioid-sparing analgesia, and early mobilization) was implemented from January 2019-December 2020). This cohort was also compared to the post-implementation cohort (January 2021-December 2024). Postoperative opioid use (measured in morphine-milligram-equivalents, MME), complication rates, and hospital length of stay (LOS) were compared. RESULTS: A total of 813 consecutive patients (748-supratentorial, 65-infratentorial) were reviewed. Post-operative opioid utilization significantly declined across cohorts: historical (136.5 MME), implementation (41.6 MME), and post-implementation (10.9 MME) (p < 0.001). In the post-implementation cohort, 76.5% of patients required no postoperative opioids, compared to 50.5% (implementation) and 25.0% (historical). Mean LOS decreased from 12.61 days [95% CI 10.3, 14.92] (historical) to 7.36 days [95% CI 6.41, 8.31] (implementation) and 6.19 days [95% CI 5.49, 6.89] (post-implementation) (p < 0.001). CONCLUSIONS: Implementation of a comprehensive, multi-modal, and generalizable pain management protocol significantly reduced opioid requirements and length of stay following craniotomy. These findings support the broader adoption of multimodal analgesia strategies to improve neurosurgical recovery.

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