Post-Craniotomy Pain Management: Beyond Opioids.
Craniotomy pain may be severe and is often undertreated. Pain management following craniotomy is a balancing act of achieving adequate analgesia but avoiding sedation, respiratory depression, hypercapnia, nausea and vomiting, and hypertension. Opioids are a first-line analgesic therapy; however, concern that opioid-related adverse effects (sedation, respiratory depression) may interfere with neurologic assessment and increase intracranial pressure has limited use of these drugs for intracranial surgery. Non-opioid analgesics avoid these effects and may be useful as part of a multimodal regimen for post-craniotomy pain. Regional scalp blocks, paracetamol, and non-steroidal anti-inflammatory drugs are beneficial in the early post-operative period. Recent studies suggest a role for novel analgesics: dexmedetomidine, gabapentinoids, and ketamine, though additional studies are necessary.
Department of Anesthesiology, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA. lak3r@virginia.edu.
Lauren K
LK
Dunn
Department of Anesthesiology, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.|Department of Neurosurgery, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.
Bhiken I
BI
Naik
Department of Anesthesiology, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.|Department of Neurosurgery, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.
Edward C
EC
Nemergut
Department of Anesthesiology, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.|Department of Neurosurgery, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA.
Marcel E
ME
Durieux
D000700:Analgesics / Q000627:therapeutic use*; D003399:Craniotomy / Q000009:adverse effects*; D006801:Humans; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology
D000700:Analgesics
Analgesia; Craniotomy; Neurosurgery; Pain; Post-operative