title: The postoperative management of pain from intracranial surgery in pediatric neurosurgical patients.
abstract: Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate-to-severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate-to-severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid-induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, α2 -adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Shay
authors.forename: Deepa
authors.initials: D
authors.lastname: Kattail
authors.forename: Athir
authors.initials: A
authors.lastname: Morad
authors.forename: Myron
authors.initials: M
authors.lastname: Yaster
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001921:Brain / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019635:Neurosurgical Procedures; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000700:Analgesics; D000893:Anti-Inflammatory Agents
keywords: age; analgesics; nervous system physiology; neurosurgery; pain management; patient-controlled analgesia; pediatric