A review of the efficacy and safety of opioid analgesics post-craniotomy.
--Codeine phosphate is the most commonly used analgesic post-craniotomy. --It is argued, in this paper, that codeine phosphate is an unpredictable pro-drug that does not equate to a safe and effective method of providing analgesia post-craniotomy. --Lack of evidence supporting tramadol's usage and concerns over its interactions and side effects mean its use cannot be advocated. --The traditional justification for withholding morphine in post-craniotomy pain appears to be largely based on anecdotal evidence. --Raising awareness among critical care nurses of the pharmacological properties of the analgesics used is imperative, if post-craniotomy pain is to be adequately treated. --There is an explicit challenge to the neurosurgical community to re-evaluate their pain-management strategies in the post-craniotomy patient.
Roberts
Gemma
G
Department of Anaesthetics, Neath-Port Talbot Hospital, Bro-Morgannwg NHS Trust, South Wales, UK. gemma.roberts@bromor-tr.wales.nhs.uk
D000701:Analgesics, Opioid / Q000009:adverse effects*; D003061:Codeine / Q000009:adverse effects; D003399:Craniotomy / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods / Q000592:standards; D019317:Evidence-Based Medicine; D006801:Humans; D009020:Morphine / Q000009:adverse effects; D024802:Nurse's Role; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000451:nursing; D011182:Postoperative Care / Q000379:methods / Q000451:nursing / Q000592:standards; D018570:Risk Assessment; D012449:Safety; D014147:Tramadol / Q000009:adverse effects; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D014147:Tramadol; D009020:Morphine; D003061:Codeine