Effectiveness of Low-Dose Intravenous Fentanyl for Postoperative Headache Management After Neck Clipping of Ruptured Intracranial Aneurysms

Terakado, Toshitsugu; Nakai, Yasunobu; Ikeda, Go; Uemura, Kazuya; Matsumaru, Yuji; Ishikawa, Eiichi; Matsumura, Akira

doi:10.1016/j.wneu.2019.10.062

Cited by 6 publications

(8 citation statements)

References 29 publications

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“…CARBOPLATIN can treat metastatic myxomatous cerebral aneurysms [ 48 ]. FENTANYL can relieve headache with little side effects after neck clipping of ruptured IA [ 49 ]. CILOSTAZOL can effectively prevent cerebral vasospasm and improve prognosis in patients with aneurysmal subarachnoid hemorrhage [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Identification of immune-related molecular markers in intracranial aneurysm (IA) based on machine learning and cytoscape-cytohubba plug-in

Zhong

Yue

et al. 2023

BMC Genom Data

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Background Intracranial aneurysm (IA) is a common cerebrovascular disease. The immune mechanism of IA is more complicated, and it is unclear so far. Therefore, it is necessary to continue to explore the immune related molecular mechanism of IA. Methods All data were downloaded from the public database. Limma package and ssGSEA algorithm was used to identify differentially expressed mRNAs (DEmRNAs) and analyze immune cell infiltration, respectively. Machine learning and cytoscape-cytohubba plug-in was used to identify key immune types and multicentric DEmRNAs of IA, respectively. Multicentric DEmRNAs related to key immune cells were screened out as key DEmRNAs by Spearman correlation analysis. Diagnostic models, competing endogenous RNA (ceRNA) regulatory network and transcription factor regulatory network were constructed based on key DEmRNAs. Meanwhile, drugs related to key DEmRNAs were screened out based on DGIdb database. The expression of key DEmRNAs was also verified by real time-PCR. Results In this study, 7 key DEmRNAs (NRXN1, GRIA2, SLC1A2, SLC17A7, IL6, VEGFA and SYP) associated with key differential immune cell infiltration (CD56bright natural killer cell, Immature B cell and Type 1 T helper cell) were identified. Functional enrichment analysis showed that VEGFA and IL6 may be involved in the regulation of the PI3K-Akt signaling pathway. Moreover, IL6 was also found to be enriched in cytokine-cytokine receptor interaction signaling pathway. In the ceRNA regulatory network, a large number of miRNAs and lncRNAs were found. In the transcription factor regulatory network, the transcription factor SP1 was correlated with VEGFA, SYP and IL6. It is also predicted that drugs related to key DEmRNAs such as CARBOPLATIN, FENTANYL and CILOSTAZOL may contribute to the treatment of IA. In addition, it was also found that SVM and RF models based on key DEmRNAs may be potential markers for diagnosing IA and unruptured intracranial aneurysm (UIA), respectively. The expression trend of key DEmRNAs verified by real-time PCR was consistent with the bioinformatics analysis results. Conclusion The identification of molecules and pathways in this study provides a theoretical basis for understanding the immune related molecular mechanism of IA. Meanwhile, the drug prediction and diagnosis model construction may also be helpful for clinical diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

Identification of immune-related molecular markers in intracranial aneurysm (IA) based on machine learning and cytoscape-cytohubba plug-in

Zhong

Yue

et al. 2023

BMC Genom Data

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“…The most commonly utilized medications for treating these post‐SAH headaches identified from the literature are opioids, and the combination medication of acetaminophen/butalbital/caffeine (A/B/C), with Viswanathan et al 73 noting in a single institution study of 114 aneurysmal SAH patients from 2012 to 2019 that 91.2% of patients received morphine and 98.3% received A/B/C for headache pain. Literature review demonstrates that thus far, pregabalin and gabapentin, 9,10,15 fentanyl, 11 lidocaine, 18 and magnesium 13,16 are the only medications to have any published findings demonstrating some level of headache improvement in post‐SAH patients, while other studies demonstrate little to no benefit for other opioids, 4,6,11,13 acetaminophen, 6,13 dexamethasone, 3,7 ketorolac, 13 ibuprofen, 13 or A/B/C; the findings of these studies with more details are summarized in Table 1 along with interventions including local nerve blockade, CSF drainage, and others 13 . Milrinone infusion has been used in some institutions for particularly severe headaches, where reversible cerebral vasospasm of various causes (not necessarily aneurysmal SAH) is thought to be etiologic 25,74,75 .…”

Section: Methodsmentioning

confidence: 99%

“…1 Severe, recurrent headaches are common in post-SAH patients, being classed as persistent headache attributed to past non-traumatic SAH if lasting for >3 months (per the International Classification of Headache Disorders, third edition, hereby referred to as post-SAH headache), 5 and their persistence for years is an important cause of post-SAH morbidity. [6][7][8] These headaches are a major clinical challenge in care, as they are the main cause of post-SAH pain; however, little data exists on the efficacy of analgesic medications and differential approaches in controlling these headaches 4,6,[9][10][11][12][13] which were briefly reviewed previously. 3 Persistent headaches are also common following ischemic stroke; 14 however, the differences in etiologic mechanism and patient population warrant focused study of these headaches in post-SAH patients.…”

Section: Introductionmentioning

confidence: 99%

Headache persisting after aneurysmal subarachnoid hemorrhage: A narrative review of pathophysiology and therapeutic strategies

et al. 2022

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Objective This narrative review of the literature concerns persistent headache attributed to past non‐traumatic subarachnoid hemorrhage (SAH), based off demographic and clinical features, what are pathophysiologic mechanisms by which these headaches occur, which medical and interventional treatments have the most evidence for pain alleviation, and what pre‐clinical evidence is there for emerging treatments for these patients. Background Following initial stabilization and treatment of spontaneous SAH, most commonly due to aneurysmal rupture, headache in the immediate inpatient setting and persisting after discharge are an important cause of morbidity. These headaches often receive heterogenous treatment of uncertain efficacy, and the risk factors and pathophysiology of their development has received little study. Methods A narrative review of current literature discussing post‐SAH headache was conducted using a literature search in PubMed with search term combinations including “post subarachnoid hemorrhage pain”, “subarachnoid hemorrhage headache”, and “post subarachnoid hemorrhage headache”. Clinical studies mentioning headache after SAH and/or treatment in the abstract/title were included through March, 2022. Results and Conclusion Post‐SAH headaches are shown to decrease quality of life, have a multi‐modal pathophysiology in their occurrence, and only a select few medications (reviewed herein) have been demonstrated to have efficacy in alleviation of these headaches, while also harboring possible risks including vasospasm and re‐bleeding. An effective treatment paradigm of these headaches will include trials of evidence‐based therapeutics, rapid reduction of opioid medications if not effective, and consideration of multi‐modal pain control strategies including nerve blocks.

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“…Severe headaches occur in up to 90% of patients admitted to ICU with SAH [6], and patients often receive a varied analgesic regimen with the most common medications including opioids [6,8,10,11], acetaminophen [6,8], dexamethasone [8,13], and combination medications of acetaminophen/butalbital/caffeine (A/B/C; Fioricet®) [8]. The impact of these common analgesic medications on the risk of DCI remains poorly understood with only one prior study evaluating the impact of certain analgesics on vasospasm (not DCI) risk, with opioids and A/B/C in particular having near signi cant association with increased vasospasm [8].…”

Section: Introductionmentioning

confidence: 99%

“…DCI has been associated with younger age and high score on the modi ed Fisher scale, however clear risk factors for DCI remain sparse [3,4]. Although promising medical and interventional therapies are undergoing trials to prevent DCI [3], few studies have evaluated associations between DCI and commonly used analgesic and anti-seizure medication dosages already utilized in the management of many SAH patients [6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

Sorrentino

Eisinger

Maciel

et al. 2022

Preprint

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Background Spontaneous aneurysmal subarachnoid hemorrhage (aSAH) recovery may be hampered by delayed cerebral ischemia (DCI). Herein, we sought to identify an association of DCI with frequently administered medications in the neurointensive care unit (neuro-ICU). Methods In this retrospective study, patients admitted to a tertiary care center neuro-ICU between 2012–2019 with aSAH who could verbalize pain intensity scores were included. Medication dosages and clinical characteristics were abstracted from the medical record. Both paired (within subjects) and unpaired (across subjects) non-parametric analyses were utilized to measure individual DCI risk for a given patient in relation to drug dosages. Results 119 patients were included; average age was 61.7 ± 15.2 (SD) years, 89 (74.7%) were female, and 32 (26.9%) experienced DCI during admission. Patients with DCI had longer length of stay (19.3 ± 7.4 vs 12.7 ± 5.3 days, p < 0.0001). The combination medication of acetaminophen 325 mg/butalbital 50 mg/caffeine 40 mg (A/B/C; Fioricet®) was associated with decreased DCI on paired (2.3 ± 2.0 vs 3.1 ± 1.9 tabs, p = 0.034) and unpaired analysis (1.84 ± 2.4 vs 2.6 ± 2.4 tabs, p < 0.001). No associations were found between DCI and opioids, dexamethasone, levetiracetam, or acetaminophen. Max and mean daily headache pain was not associated with DCI occurrence. Conclusion We identified a dose-response relationship between a commonly administered analgesic and DCI. A/B/C is associated with decreased DCI in this study both within and across subjects, while other medications are not associated with DCI.

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Effectiveness of Low-Dose Intravenous Fentanyl for Postoperative Headache Management After Neck Clipping of Ruptured Intracranial Aneurysms

Abstract: Click here to download Manuscript (Must be in .doc or .docx format): Manuscript 20191009 clean.docx Click here to view linked References

Cited by 6 publications

References 29 publications

Identification of immune-related molecular markers in intracranial aneurysm (IA) based on machine learning and cytoscape-cytohubba plug-in

Identification of immune-related molecular markers in intracranial aneurysm (IA) based on machine learning and cytoscape-cytohubba plug-in

Headache persisting after aneurysmal subarachnoid hemorrhage: A narrative review of pathophysiology and therapeutic strategies

Evaluating common medications utilized in aneurysmal subarachnoid hemorrhage and association with delayed cerebral ischemia

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