Prospective Assessment of Postoperative Pain After Craniotomy

Mordhorst, Christine; Latz, Björn; Kerz, Thomas; Wisser, G.; Schmidt, Annette; Schneider, Astrid; Jahn-Eimermacher, Annette; Werner, Christian; Engelhard, Kristin

doi:10.1097/ana.0b013e3181df0600

Cited by 113 publications

(91 citation statements)

References 31 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]. Our results are consistent with previous reports, with 52% of the diclofenac patients and 73% of the control patients reporting moderate-to-severe pain the day after surgery.…”

Section: Discussionsupporting

confidence: 91%

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: Discussionsupporting

confidence: 91%

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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“…Prospective observational studies showed that a substantial number of patients (approximately 50%) suffered from moderate to severe pain during the first postoperative day after craniotomy 34–36. In a recent study by Mordhorst et al,34 55% of patients had moderate or severe postoperative pain in the first 24 hours following craniotomy. This study had a result similar to the pilot study by De Benedittis et al,37 in which 60% of patients experienced postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial

Zhao

Shi

Chen

et al. 2017

Journal of Neurosurgical Anesthesiology

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Background:We conducted a randomized trial to evaluate the efficacy and safety of dexmedetomidine for prophylactic analgesia and sedation in patients with delayed extubation after craniotomy.Methods:From June 2012 to July 2014, 150 patients with delayed extubation after craniotomy were randomized 1:1 and were assigned to the dexmedetomidine group that received a continuous infusion of 0.6 μg/kg/h (10 μg/mL) or the control group that received a maintenance infusion of 0.9% sodium chloride for injection. The mean percentage of time under optimal sedation (SAS3-4), the percentage of patients who required rescue with propofol/fentanyl, and the total dose of propofol/fentanyl required throughout the course of drug infusion, as well as VAS, HR, MAP, and SpO2 were recorded.Results:The percentage of time under optimal sedation was significantly higher in the dexmedetomidine group than in the control group (98.4%±6.7% vs. 93.0%±16.2%, P=0.008). The VAS was significantly lower in the dexmedetomidine group than in the control group (1.0 vs. 4.0, P=0.000). The HR and mean BP were significantly lower in the dexmedetomidine group than in the control group at all 3 time points (before endotracheal suctioning, immediately after extubation, and 30 min after extubation). No significant difference in SpO2 was observed between the 2 groups. For hemodynamic adverse events, patients in the dexmedetomidine group were more likely to develop bradycardia (5.3% vs. 0%, P=0.043) but had a lower likelihood of tachycardia (2.7% vs. 18.7%, P=0.002).Conclusions:Dexmedetomidine may be an effective prophylactic agent to induce sedation and analgesia in patients with delayed extubation after craniotomy. The use of dexmedetomidine (0.6 μg/kg/h) infusion does not produce respiratory depression, but may increase the incidence of bradycardia.

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“…In a recent study by Mordhorst et al . [2], 55% of patients had moderate or severe postoperative pain in the first 24 hours following craniotomy. This study had a similar result to the pilot study by De Benedittis et al .…”

Section: Introductionmentioning

confidence: 99%

Use of dexmedetomidine for prophylactic analgesia and sedation in delayed extubation patients after craniotomy: a study protocol and statistical analysis plan for a randomized controlled trial

Zhao

Shi

Yin

et al. 2013

Trials

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BackgroundPain and agitation are common in patients after craniotomy. They can result in tachycardia, hypertension, immunosuppression, increased catecholamine production and increased oxygen consumption. Dexmedetomidine, an alpha-2 agonist, provides adequate sedation without respiratory depression, while facilitating frequent neurological evaluation.Methods/designThe study is a prospective, randomized, double-blind, controlled, parallel-group design. Consecutive patients are randomly assigned to one of the two treatment study groups, labeled ‘Dex group’ or ‘Saline group.’ Dexmedetomidine group patients receive a continuous infusion of 0.6 μg/kg/h (10 ug/ml). Placebo group patients receive a maintenance infusion of 0.9% sodium chloride for injection at a volume and rate equal to that of dexmedetomidine. The mean percentages of time in optimal sedation, vital signs, various and adverse events, the percentage of patients requiring propofol for rescue to achieve/maintain targeted sedation (Sedation-Agitation Scale, SAS 3 to 4) and total dose of propofol required throughout the study drug infusion are collected. The percentage of patients requiring fentanyl for additional rescue to analgesia and total dose of fentanyl required are recorded. The effects of dexmedetomidine on hemodynamic and recovery responses during extubation are measured. Intensive care unit and hospital length of stay also are collected. Plasma levels of epinephrine, norepinephrine, dopamine, cortisol, neuron-specific enolase and S100-B are measured before infusion (T1), at two hours (T2), four hours (T3) and eight hours (T4) after infusion and at the end of infusion (T5) in 20 patients in each group.DiscussionThe study has been initiated as planned in July 2012. One interim analysis advised continuation of the trial. The study will be completed in July 2013.Trial registrationClinicalTrials (NCT): ChiCTR-PRC-12002903.

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Prospective Assessment of Postoperative Pain After Craniotomy

Cited by 113 publications

References 31 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

Use of Dexmedetomidine for Prophylactic Analgesia and Sedation in Patients With Delayed Extubation After Craniotomy: A Randomized Controlled Trial

Use of dexmedetomidine for prophylactic analgesia and sedation in delayed extubation patients after craniotomy: a study protocol and statistical analysis plan for a randomized controlled trial

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