Multimodal analgesia for craniotomy

Ban, Vin Shen; Bhoja, Ravi; McDonagh, David L.

doi:10.1097/aco.0000000000000766

Cited by 48 publications

(48 citation statements)

References 25 publications

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“…Opioids can produce anxiolysis and could reduce the incidence of pain during the procedure and have been used by other groups 7 . The fear of increasing the probability of vomiting and pulmonary aspiration with opioids led us to the use of dexmedetomidine because of its analgesic and antiemetic properties 22–25 . In our study, dexmedetomidine does not seem to play a role in MRI/ultrasound‐related events.…”

Section: Discussionmentioning

confidence: 60%

“…7 The fear of increasing the probability of vomiting and pulmonary aspiration with opioids led us to the use of dexmedetomidine because of its analgesic and antiemetic properties. [22][23][24][25] In our study, dexmedetomidine does not seem to play a role in MRI/ultrasound-related events. Its use was not associated with a decrease in headache or nausea treatment requirements.…”

Section: Discussionmentioning

confidence: 78%

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Factors Associated with Headache and Nausea During Magnetic Resonance–Guided Focused Ultrasound for Tremor

Cacho‐Asenjo

Honorato‐Cia

Núñez‐Córdoba

et al. 2021

Movement Disord Clin Pract

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BackgroundBackground: During magnetic resonance-guided focused ultrasound for essential or parkinsonian tremor, adverse events (headache, nausea/vomiting, or anxiety) may alter the outcome of the procedure despite being mostly transient and mild. Objectives Objectives: Our aim was to analyze the relationship between demographic, procedural, and anesthetic characteristics with magnetic resonance/ultrasound-related events. Methods Methods: This was a retrospective study at the Clinica Universidad de Navarra of patients undergoing thalamotomy with magnetic resonance-guided focused ultrasound between September 2018 and October 2019. The anesthesia protocol included headache and nausea/vomiting prophylaxis and rescue therapy. Dexmedetomidine was used for anxiolysis in some patients after thorough multidisciplinary assessment. Results Results: A total of 123 patients were included. Headache was directly related to skull density ratio (P < 0.001) and skull thickness (P = 0.02). Patients with a skull density ratio less than 0.48 had 3 times the odds of experiencing moderate or severe headache (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.21-7.82) and had a higher odds of aborting sonication due to pain. Sex was associated with increased nausea (P = 0.007). Women had 4 times the odds of nausea than men (OR, 4.4; 95% CI, 1.61-12.11). Dexmedetomidine did not reduce headache or nausea incidence. Patients who received dexmedetomidine had a higher number (P = 0.01) and total minutes of sonication (P = 0.01). Conclusions Conclusions: Patients with lower skull density ratios and higher skull thicknesses could benefit from an aggressive analgesic prophylaxis. Women are more likely to experience nausea. Dexmedetomidine did not reduce headache and nausea, but increased the number and duration of sonications. Its exact effect on tremor is still unclear.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 78%

Factors Associated with Headache and Nausea During Magnetic Resonance–Guided Focused Ultrasound for Tremor

Cacho‐Asenjo

Honorato‐Cia

Núñez‐Córdoba

et al. 2021

Movement Disord Clin Pract

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“…Moreover, the quality improvement methods should raise the degree of patients' perceived comfort 12 , 13 . Acute pain is common during the postoperative period, and is associated with complications and adverse outcomes 14 , 15 . To date, there is controversy in the literature regarding the evaluation of pain and its intensity in patients undergoing neurosurgical procedures 16 , 17 .…”

Section: Introductionmentioning

confidence: 99%

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

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“…Una de las estrategias actuales para abordar el control del dolor es la analgesia multimodal. Este concepto implica que la asociación de diferentes intervenciones analgésicas por diferentes vías, consiguen una efectividad mayor sobre su utilización única, disminuye los efectos secundarios y aumenta la satisfacción de los pacientes, especialmente porque los efectos de un enfoque multimodal se consideran sinérgicos más que aditivos (21) . La analgesia multimodal se recomienda para el manejo del dolor perioperatorio pediátrico (22) .…”

Section: Discussionunclassified

Analgesia postoperatoria para craneotomías en pediatría: experiencia en un Hospital de Tercer Nivel

León-Álvarez

Ortiz-Bautista

Ortega-Munguía

et al. 2021

Revista Mexicana De Anestesiología

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Existe la creencia de que los pacientes no experimentan dolor intenso después de cirugía intracraneal. La estimulación simpática secundaria a dolor puede ocasionar hipertensión intracraneal y sangrado postoperatorio. Es controvertido el uso de opioides para analgesia postcraneotomías por temor a sus efectos colaterales que pueden enmascarar signos de alteración neurológica. En pediatría hay estudios limitados. Objetivo: Describir el nivel de control del dolor postcraneotomías al usar buprenorfina ketorolaco y ondansetrón en pacientes pediátricos. Métodos: Estudio de cohorte descriptivo. Incluimos niños de 0-17 años programados para cirugía intracraneal electiva. Para el control del dolor se administró buprenorfina, ketorolaco y ondansetrón en infusión por 30 horas. Se investigó dolor al iniciar la infusión a las cuatro, ocho, 12, 24 y 30 horas; variables hemodinámicas y grado de sedación. Resultados: 109 pacientes fueron incluidos. Se observó adecuado control del dolor en 71.56%, 28.4% tuvo control insuficiente con una diferencia estadísticamente significativa (p < 0.001). Hubo sedación moderada en 5.6% iniciando la infusión y a las 24 horas (4.5%) sin repercusión hemodinámica. Se detectó náusea en 8.2% y vómito en 6.64%; no se presentó sedación profunda, ni depresión respiratoria. Conclusiones: Estos hallazgos sugieren que es una opción efectiva para tratar el dolor postcraneotomías en pediatría. ABSTRACT. Introduction:There is still a belief that patients do not experience intense pain after intracranial surgery. Sympathetic stimulation associated with pain can lead to elevated intracranial pressure and postoperative haemorrhage. There is controversy about the use of opioids for postoperative analgesia in craniotomies, owing to fear of its side effects, which can mask signs of neurological alteration. There are limited studies in the pediatric patient for post-craniotomy analgesia. Objective: To describe the postcraneotomies pain control level, using buprenorphine in partnership with ketorolac and ondansetron in pediatric patients. Methods: Descriptive cohort study. For postoperative pain control, patients were given continuous infusion buprenorphine, ketorolac and ondansetron for 30 hours. The main variables to investigate were pain at beginning of infusion, at four, eight, 12, 24 and 30 hours, hemodynamic variables and depth of sedation. Results: 109 patients were included. Adequate control of pain was observed in 71.56% of patients, whereas in 28.4% insufficient control was found, with a statistically significant difference (p < 0.001). There was moderate sedation in 5.6% of the patients at the start of infusion and at 24 hours (4.5%), without significant impact on hemodynamic variables. Nausea was found in 8.2% and vomiting in 6.64%. No deep sedation, or respiratory depression was presented. Conclusions: These findings suggest that is an effective option to treat postcraneotomy pain in pediatric patients.

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Multimodal analgesia for craniotomy

Cited by 48 publications

References 25 publications

Factors Associated with Headache and Nausea During Magnetic Resonance–Guided Focused Ultrasound for Tremor

Factors Associated with Headache and Nausea During Magnetic Resonance–Guided Focused Ultrasound for Tremor

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Analgesia postoperatoria para craneotomías en pediatría: experiencia en un Hospital de Tercer Nivel

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