2026 Proffered Presentations
S104: IMPACT OF A COMPREHENSIVE MULTI-MODAL PERIOPERATIVE PROTOCOL AFTER MICROVASCULAR DECOMPRESSION
Nikita Gonugunta, BS1; Kate Easley, PAC2; Pranay Soni, MD2; Pablo F Recinos, MD2; Varun R Kshettry, MD2; 1Case Western Reserve University School of Medicine; 2Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurologic Institute, Cleveland Clinic
Background: Microvascular decompression (MVD) is a well-established and effective neurosurgical procedure. However, MVD can result in significant postoperative pain, headache and nausea, which can prolong length of stay (LOS) and overall recovery. Thus, a surgical and perioperative enhanced recovery after surgery (ERAS) protocol can potentially mitigate pain and nausea and improve recovery and LOS. This study aimed to determine the impact of an ERAS protocol on postoperative outcomes, including length of stay (LOS), patient-reported pain, antiemetics use and opioid use among patients undergoing MVD for TN.
Methods: A retrospective cohort study was conducted of patients who underwent MVD for TN before (2011-2016) and after (2017-2022) protocol implementation. Outcomes included opioid consumption (converted to morphine milligram equivalents (MME)) within the first 72 hours after surgery, doses of antiemetics administered, patient-reported pain scores, and LOS. Continuous variables were compared using the independent t-test or Mann-Whitney U-test. Categorical variables were tested using the chi-squared test or Fisher's exact test. Multivariable linear and logistic regression models assessed the independent effect of protocol implementation on outcomes, adjusting for confounders.
Results: A total of 148 patients were included (2011–2016: n=75; 2017–2022: n=73). Baseline demographics were similar, though the latter cohort had lower rates of preoperative facial hypesthesia (p=0.039). Patients in the 2017–2022 cohort required fewer opioids, with mean MME reduced at the first 24 hours (58.2 vs. 91.1, p=0.0025), 48 hours (74.9 vs 123.9, p=0.0011), and 72 hours (139.3 vs 223.7, p=0.0019) after surgery. Pain scores at 8 hours and 24 hours after surgery were significantly lower (p=0.046, p=0.034), and antiemetic use decreased across multiple agents (all p<0.01). On multivariable regression, the 2017–2022 cohort remained independently associated with reduced opioid use at 24h (β = –14.4, p=0.018), 48h (β = –21.5, p=0.010), and 72h (β = –36.4, p=0.015), after adjustment for age and baseline factors. Increasing age was also linked to lower opioid requirements (p<0.0001). LOS was not statistically shorter in the later cohort (mean 2.30 vs. 2.51 days, p=0.37), with multivariate models identifying age and baseline pain intensity as predictors of total LOS. Rates of POD1 discharge were 18.7% in 2011–2016 and 26.0% in 2017–2022 (p=0.28), with no significant difference between cohorts.
Conclusion: Adoption of a standardized perioperative protocol for MVD was associated with reduced postoperative opioid use, lower pain scores, and decreased antiemetic requirements. These findings suggest that protocol-driven multimodal care can enhance recovery after MVD. Further study is necessary to externally validate preliminary findings.