Pain following Craniotomy: Reassessment of the Available Options

Abstract

Pain following craniotomy has frequently been neglected because of the notion that postcraniotomy patients do not experience severe pain. However a gradual change in this outlook is observed because of increased sensitivity of neuroanaesthesiologists and neurosurgeons toward acute postcraniotomy pain. Multiple modalities exist for treating this variety of pain each with its own share of advantages and disadvantages. However, individually none of these modalities has been proclaimed as the best and applicable universally. A considerable amount of dispute remains to ascertain the appropriate therapeutic regimen for treating postcraniotomy pain in spite of numerous trials using different drugs and their combinations. This review aims to highlight the genesis, characteristics, and different strategies that are undertaken for management of acute postcraniotomy pain. Chronic postcraniotomy pain which can be debilitating sequelae is also discussed concisely.

Review in The Management of Post-Craniotomy Pain

“…Infi ltration of some drugs like Bupivacine 0.5% or Ropivacaine with or without Lidocaine has been found to signifi cantly reduce PCP without any side effects and last till 48 hours. 11,13,14,26,36 This can be supplemented with nerve blocks like maxillary nerve block, for further pain control. Figure 1 shows the nerves supplying the scalp where blocks can be made.…”

Analisis Masalah Keperawatan pada Pasien Post Kraniotomi di RSD Dr. Soebandi Jember (Studi Retrospektif Januari 2016 – Desember 2017)

“…Nyeri merupakan akibat umum dari cedera kepala pada pasien post kranotomi. Pasien yang melakukan operasi untuk cedera kepala lebih memiliki kecenderungan mengalami nyeri hingga mengembangkan kondisi kronis (Haldar, 2015).kejadian masalah keperawatan nyeri akut post kraniotomi saat ini disebabkan karena faktor preoperatif, intra-operatif, dan post-operatif. Selain faktor perioperatif, terdapat faktor pasien yaitu setiap individu mempunyai tingkat intensitas nyeri yang berbeda.…”

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

“…Pain following craniotomy has been neglected in the past, mostly because of the common belief that craniotomy pain is mild to moderate in intensity, and it has been the subject of limited and inconsistent research . Currently, this aspect is debatable as a body of accumulating evidence shows that approximately 60% of postcraniotomy patients experience moderate or severe pain in the early postoperative period, or present with persistent pain with neuropathic elements several months postsurgery .…”

“…The evolving awareness on this issue has led to a growing number of published articles in the past years assessing the safety and efficacy of traditional and novel analgesic modalities for postcraniotomy pain management . Although several analgesic regimens have been tested aiming to reduce the need for opioids, the optimal form of analgesic therapy remains unidentified.…”

“…Pain following craniotomy has been neglected in the past, mostly because of the common belief that craniotomy pain is mild to moderate in intensity, and it has been the subject of limited and inconsistent research. 1,2 Currently, this aspect is debatable as a body of accumulating evidence shows that approximately 60% of postcraniotomy patients experience moderate or severe pain in the early postoperative period, or present with persistent pain with neuropathic elements several months postsurgery. [3][4][5][6] Thus, postcraniotomy pain approach might balance between proper analgesia establishment, while having an awake and cooperative patient to accomplish neurological evaluation and suboptimal pain treatment that might induce an implicated postoperative course, resulting in increased healthcare expenditures.…”