(1217) Impact of Nasoseptal Flap on Postoperative Pain and Opioid Use

Introduction: Understanding the impact of the nasoseptal flap (NSF) on pain after endoscopic endonasal transsphenoidal approaches (EETA) is important for patient care and appropriate use of analgesics. We compared acute postoperative pain scores and rescue opioid use (ROU) in the first 24 hours after EETA in patients who had skull base reconstruction with or without the NSF.

Methods: We retrospectively analyzed 52 adults diagnosed with pituitary adenoma who underwent EETA at our institution between 2018-2023. Cases with concomitant septoplasty, sinus surgery and nasal packing with local analgesics were excluded. Pain scores (PS) were assessed using the visual analog scale and ROU was quantified in morphine milligram equivalents.

Results: The mean patient age was 55 years. The average PS in 24-hours postoperative was 3.04. 46% of these patients underwent NSF reconstruction (n = 24). On average, surgery was 21 minutes longer in the cases with the NSF (191 vs 162 minutes, p = 0.078). Overall, there were no significant differences in patient factors, surgical factors and PS between the NSF and non-NSF groups. PS in NSF group were higher across time periods ranging between 3.65 to 5.6 compared to non-NSF ranging between 2.96 to 4.27 which was not significant, and ROU was not significantly higher in NSF cohort (24.86 vs 22.12).

Conclusions: We found no significant difference in PS between patients with NSF and non-NSF after EETA. PS and ROU were moderate and similar between the groups. These findings suggest that NSF for reconstruction does not significantly increase 24-hour postoperative pain and opioid use.