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Impact Of Preoperative Narcotic Use On Outcomes In Migraine Surgery
Paul Adenuga BS; Matthew Brown MD; Dr. Deborah Reed MD; Bahman Guyuron MD.
University Hospital Case Medical Center
2014-03-08
Presenter: Paul O Adenuga
Affidavit:
Director Name:
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction
This study focuses on the impact of preoperative narcotic medication use on outcomes of surgical treatment of migraine headaches (MH).
Methods
A retrospective comparative review was conducted with patients undergoing migraine surgery. Data gathered included demographic information, baseline migraine headache characteristics, migraine surgery sites, postoperative MH characteristics 1 year or more following surgery and preoperative migraine medication use. Patients were grouped based on preoperative narcotic medication use. The narcotic users were subdivided into low and high narcotic user groups. Preoperative migraine characteristics were comparable between groups and the outcomes of migraine surgery were compared among the groups.
Results
Outcomes in 90 narcotic users were compared with those for 112 patients not using narcotic medications preoperatively. Narcotic users showed statistically significantly less reduction in frequency, severity, and duration of migraine headaches after surgery. Narcotic users had clinical improvement in 66.7% of patients and elimination in 18.9% versus 86.6% and 36.6% in the non-narcotic group. The group that consumed narcotics had significantly lower rates of improvement in all migraine indices.
Conclusion
Previous studies have discouraged the routine use of narcotic medications in the management of migraine medications. Our study demonstrates narcotic medication use prior to MH surgery may predispose patients to worse outcomes postoperatively. Since pain cannot be objectively documented the question remains whether this failure to improve the pain was indeed suboptimal response to the surgery or the need for narcotic substances.
