title: Pain management in post-craniotomy patients: a survey of canadian neurosurgeons.
abstract: BACKGROUND
  Despite the growing recognition for analgesic needs in post-craniotomy patients, this remains a poorly studied area in neurological surgery. The class and regimen of analgesia that is most suitable for these patients remains controversial. The objective of this study is to examine the current beliefs and practices of Canadian neurosurgeons when managing post-craniotomy pain.
  
  
  METHODS
  A survey was sent to all practicing Canadian neurosurgeons to examine the following aspects of analgesia in craniotomy patients: type of analgesics used, common side effects encountered, satisfaction with current regimen and the rationale for their practice.
  
  
  RESULTS
  Of 156 potential respondents, 103 neurosurgeons (66%) completed the survey. Codeine (59%) was the most prescribed first line analgesic followed by morphine (38%). The use of a second-line opioid was significantly higher among codeine prescribers compared to morphine, 53% compared to 28% (p < 0.001). Nausea, constipation and neurologic depression were reported as common side effects by 76%, 66% and 27% of respondents respectively. Of the respondents, 90% reported a high level of satisfaction with their current choice of analgesia; nonetheless, they predominantly described their practice as personal preference or protocol driven rather than evidence-based.
  
  
  CONCLUSIONS
  Codeine - a weak opioid - is the most common first-line analgesic prescribed to craniotomy patients. This practice is associated with substantially increased reliance on potent opioids for rescue analgesia. Whether novel regimens can provide optimal pain control while minimizing neurologic and gastrointestinal side effects remains to be addressed by future trials.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Basil
authors.initials: B
authors.lastname: Hassouneh
authors.forename: John E
authors.initials: JE
authors.lastname: Centofanti
authors.forename: Kesava
authors.initials: K
authors.lastname: Reddy
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D003399:Craniotomy / Q000009:adverse effects*; D006306:Health Surveys; D006801:Humans; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology* / Q000628:therapy*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data
chemical_list: D000700:Analgesics