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Post-Craniotomy Pain Management: Beyond Opioids

  • Critical Care (SA Mayer, Section Editor)
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Abstract

Craniotomy pain may be severe and is often undertreated. Pain management following craniotomy is a balancing act of achieving adequate analgesia but avoiding sedation, respiratory depression, hypercapnia, nausea and vomiting, and hypertension. Opioids are a first-line analgesic therapy; however, concern that opioid-related adverse effects (sedation, respiratory depression) may interfere with neurologic assessment and increase intracranial pressure has limited use of these drugs for intracranial surgery. Non-opioid analgesics avoid these effects and may be useful as part of a multimodal regimen for post-craniotomy pain. Regional scalp blocks, paracetamol, and non-steroidal anti-inflammatory drugs are beneficial in the early post-operative period. Recent studies suggest a role for novel analgesics: dexmedetomidine, gabapentinoids, and ketamine, though additional studies are necessary.

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  1. Department of Anesthesiology, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA

    Lauren K. Dunn, Bhiken I. Naik, Edward C. Nemergut & Marcel E. Durieux

  2. Department of Neurosurgery, University of Virginia, PO BOX 800710, Charlottesville, VA, 22908, USA

    Bhiken I. Naik, Edward C. Nemergut & Marcel E. Durieux

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  1. Lauren K. Dunn
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  2. Bhiken I. Naik
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Lauren K. Dunn, Bhiken I. Naik, Edward C. Nemergut, and Marcel E. Durieux declare that they have no conflict of interest.

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Dunn, L.K., Naik, B.I., Nemergut, E.C. et al. Post-Craniotomy Pain Management: Beyond Opioids. Curr Neurol Neurosci Rep 16, 93 (2016). https://doi.org/10.1007/s11910-016-0693-y

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