Postoperative Pain in Neurosurgery: A Pilot Study in Brain Surgery

Benedittis, Giuseppe De; Lorenzetti, Aldo; Migliore, Matteo; Spagnoli, D.; Tiberio, F.; Villani, R.

doi:10.1227/00006123-199603000-00008

Cited by 59 publications

(113 citation statements)

References 13 publications

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“…In the largest case series, two-thirds of the patients reported moderate-to-severe headache after craniotomy [4]. A more recent study indicated that 55% of craniotomy patients report moderate-to-severe pain in the first 24 hours [13].…”

Section: Discussionmentioning

confidence: 97%

“…Infratentorial craniotomies are apparently more likely to provoke chronic postcraniotomy headaches than supratentorial procedures [4] , [3]. Interestingly, preventive treatment with diclofenac was more effective for infratentorial than supratentorial operations.…”

Section: Accepted M Manuscriptmentioning

confidence: 96%

“…De Benedittis first recognized that the incidence of PCH is as high as 60%, and that two-third of craniotomy patients report moderate to severe headaches [4].…”

Section: Introductionmentioning

confidence: 99%

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A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

Molnár¹,

Simon²,

Kazup³

et al. 2015

Journal of the Neurological Sciences

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A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: a single center, randomized, blinded trial This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. KTIA_13_NAP-A-II/5. None of the authors has a personal financial interest in this research. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 2 AbstractObjective: Postcraniotomy headache causes considerable pain and can be difficult to treat. We therefore tested the hypothesis that a single 100-mg preoperative dose of diclofenac reduces the intensity of postcraniotomy headache, and reduces analgesic requirements.Methods: 200 patients having elective craniotomies were randomly assigned to diclofenac (n=100) or control (n=100). Pain severity was assessed by an independent observer using a 10-cm-long visual analogue scale the evening of surgery, and on the 1st and 5th postoperative days. Analgesics given during the first five postoperative days were converted to intramuscular morphine equivalents.Results were compared using Mann-Whitney-tests; P<0.05 was considered statistically significant.Results: Baseline and surgical characteristics were comparable in the diclofenac and control groups. Visual analogue pain scores were slightly, but significantly lower with diclofenac at all times (means and 95% confidence intervals): the evening of surgery, 2.47 (1.8-3.1) vs. 4. 37(5.0-3.7), (P<0.001); first postoperative day, 3.98 (3.4-4.6) vs.5.6 (4.9-6.2) cm (P<0.001) and 5th postoperative day: 2.8 (2.2-3.4) vs. 4.0 ± (3.3-4.7) cm (P = 0.013). Diclofenac reduced systemic analgesic requirements over the initial five postoperative days (mean and 95% CI): 3.3 (2.6 -3.9) vs. 4.3 (3.5-5.1) mg morphine equivalents (p<0.05). Conclusions: Preoperative diclofenac administration reduces postcraniotomyheadache and postoperative analgesic requirements -a benefit that persisted throughout five postoperative days.

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Section: Discussionmentioning

confidence: 97%

Section: Accepted M Manuscriptmentioning

confidence: 96%

See 1 more Smart Citation

A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

Molnár¹,

Simon²,

Kazup³

et al. 2015

Journal of the Neurological Sciences

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show abstract

“…[1][2][3] Postcraniotomy pain is described as superficial in the majority of patients, suggesting a prominent role of pericranial muscles and soft tissue in its genesis. 1 Observations from a few studies indicate, mainly as a secondary finding, that the severity of pain might be linked to the site of craniotomy.…”

mentioning

confidence: 99%

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Thibault

Girard

Moumdjian

et al. 2007

Can J Anesth/J Can Anesth

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Objective: This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy. Methods:After Research Ethics Board approval, data were collected from the charts of all patients who underwent a craniotomy at our institution between January 2004 and December 2005. The severity of post-craniotomy pain was assessed by collecting scores obtained using an 11-point verbal rating scale and calculating the cumulative analgesic requirements for the first 48 hr postoperatively. Data were compared according to the craniotomy location. Results:Data from 299 patients was available for analysis. On average, 76% of patients experienced moderate to severe postoperative pain. Frontal craniotomy was associated with lower pain scores than four of six craniotomy sites analyzed, with 49% of patients reporting mild pain, a significant difference (P < 0.05) compared with all other groups except for parietal craniotomies. Frontal craniotomy patients also had lower opioid analgesic requirements compared to patients who underwent posterior fossa craniotomy (P < 0.05). Logistic regression analysis showed that craniotomy location (P < 0.0001) and age (P = 0.004) were both independent predictors of the intensity of postoperative pain, with lower pain scores as age increased. Postoperative use of steroids, gender and presence of preoperative pain were not statistically linked to postoperative pain intensity. The prevalence of postoperative nausea and vomiting was 56% and it did not vary according to the location of craniotomy. Conclusion:This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.

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“…Patients undergoing craniotomy have traditionally been thought to experience minimal postoperative pain; 2 however, newer evidence suggests that neurosurgical patients receive inadequate analgesia from currently available regimens. In a preliminary study of craniotomy patients, De Benedittis, et al, 6 reported that 60% of all patients who undergo craniotomy experience moderate to severe postoperative pain. Of these, 90% experienced pain in the first 12 hours after surgery, which lasted up to 48 hours.…”

Section: Postoperative Carementioning

confidence: 99%

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

Jellish¹,

Murdoch²,

Jp³

2002

FOC

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The anesthetic management of complex skull base surgical procedures provides unique problems and concerns for the neuroanesthesiologist. Positioning to access the skull base could put the patient at risk for peripheral nerve injury and some of the positions may increase the risk for air emboli. In addition, tumor pathology and involvement with vital structures could increase the chances for substantive blood loss, destruction of associated nerves or vessels, and may require temporary occlusion of the carotid artery necessitating intraoperative neuroprotection. Neurophysiological monitors may also be used to safeguard nerve function and anesthetic techniques must be adjusted to accommodate their use. Finally, postoperative morbidity may be affected by surgical approach to the skull base and the anesthesiologist should be aware of which approach may produce a greater incidence of pain, nausea, and vomiting in the postoperative period. The authors discuss the anesthetic concerns and management for complex cranial base surgery. Different approaches will be discussed and comparisons of perioperative parameters between these approaches will be made with data provided by retrospective chart review of more than 600 skull base procedures performed at the authors' institution over the last 10 years. This information should help guide decision making concerning anesthetic management for these skull base procedures.

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Postoperative Pain in Neurosurgery: A Pilot Study in Brain Surgery

Cited by 59 publications

References 13 publications

A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Perioperative management of complex skull base surgery: the anesthesiologist's point of view

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