Preoperative opioid use and postoperative outcomes after primary percutaneous glycerin rhizotomy for trigeminal neuralgia.

OBJECTIVES

The utilization of opioids for the management of trigeminal neuralgia (TN) is controversial. Here, we examined the clinical outcomes following percutaneous glycerin rhizotomy (GR) for TN among patients with and without preoperative opioid use.

METHODS

We reviewed the electronic medical records for TN patients who underwent primary GR at our institution from 2011 to 2022. Patients were categorized by preoperative opioid use (users vs. nonusers). Pain recurrence was defined as a modified Barrow Neurological Institute (BNI) pain score ≥ 3, indicating the need for medications to control pain. We used Kaplan-Meier survival analysis to estimate the cumulative pain-free survival by preoperative opioid use.

RESULTS

Out of 371 TN patients who underwent primary GR, 87 (23.5%) utilized opioids preoperatively. At first follow-up, preoperative opioid users had higher modified BNI pain scores, compared to nonusers (median [5th - 95th percentile], 5 [2-6] vs 4 [1-5], p = 0.003), and this association persisted ausefter adjustment but was attenuated at final follow-up. At 12 months, cumulative pain-free survival was 24.0% (95% CI, 14.7-34.5) among preoperative opioid users compared to 34.6% (95% CI, 28.3-40.8) among nonusers, but this difference was attenuated over longer durations of follow-up.

CONCLUSION

In this study of 371 patients who underwent primary GR for TN, we found that patients utilizing preoperative opioids had worse postoperative pain and an increased risk of pain recurrence in the short-term. These patients should be counseled about the reduced short-term efficacy of GR for TN pain relief.