Skip to main content

Acute Pain Management Protocol for Cranial Procedures

  • Chapter
  • First Online:
First Aid Perioperative Ultrasound

Abstract

Targeted blockade of the nerves of the scalp have been found to be beneficial for many different types of surgeries of the head, as well as for some nonsurgical conditions. Craniotomy has been the most widely studied surgical procedure of the head, and it is associated with a high risk of severe acute and chronic pain. Several techniques to combat this pain include the use of multimodal analgesia, infiltration of local anesthetic, and the regional technique of scalp blocks. The common indications for scalp blocks include extracranial surgery, blunting of the hemodynamic response to intracranial surgery, and reducing acute and chronic pain following intracranial surgery. Its evolving role in decreasing acute and chronic pain parallels that of other types of neural blockade, and efforts to find efficacious combinations of procedure, patient, and technique are ongoing. However, the fact that extracranial blockade of the dura is not possible is one of the limits to the analgesia provided by scalp blockade (Papangelou et al., J Clin Anesth 25:150–159, 2013.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cuadrado M, Aledo-Serrano Á, Navarro P, et al. Short-term effects of greater occipital nerve blocks in chronic migraine: a double-blind, randomized, placebo-controlled clinical trial. Cephalalgia. 2017;37:864–72.

    Article  PubMed  Google Scholar 

  2. Tang Y, Kang J, Zhang Y, et al. Influence of greater occipital nerve block on pain severity in migraine patients: a systematic review and metaanalysis. Am J Emerg Med. 2017;35:1750–4.

    Article  PubMed  Google Scholar 

  3. Juškys R, Šustickas G. Effectiveness of treatment of occipital neuralgia using the nerve block technique: a prospective analysis of 44 patients. Acta Med Litu. 2018;25:53–60.

    PubMed  PubMed Central  Google Scholar 

  4. De Gray L, Matta B. Acute and chronic pain following craniotomy: a review. Anaesthesia. 2005;60:693–704.

    Article  PubMed  Google Scholar 

  5. Bin Saif G, Ericson M, Yosipovitch G. The itchy scalp—scratching for an explanation. Exp Dermatol. 2011;20:959–68.

    Article  CAS  PubMed  Google Scholar 

  6. NYSORA. Local and regional anesthesia for ophthalmic surgery. Available at https://www.nysora.com/regional-anesthesia-for-specific-surgicalprocedures/head-and-neck/ophthalmic/local-regional-anesthesia-ophthalmicsurgery/

  7. Cohen-Gadol A, Kemp W III, Tubbs R. The innervation of the scalp: a comprehensive review including anatomy, pathology, and neurosurgical correlates. Surg Neurol Int. 2011;2:178.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Liu G. The Trigeminal nerve and its central connections. Walsh and Hoyt’s Clinical Neuroophthalmology, vol. 1. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 1233–41.

    Google Scholar 

  9. NYSORA. Nerve block of the face. Available at https://www.nysora.com/techniques/head-and-neck-blocks/nerve-blocks-face/. Accessed Nov 2021.

  10. Natsis K, Baraliakos X, Appell H, et al. The course of the greater occipital nerve in the suboccipital region: a proposal for setting landmarks for local anesthesia in patients with occipital neuralgia. Clin Anat. 2006;19:332–6.

    Article  CAS  PubMed  Google Scholar 

  11. Muse I, Straker T. A comprehensive review of regional anesthesia for head and neck surgery. J Head Neck Anesthes. 2021;5:e33. https://doi.org/10.1097/HN9.0000000000000033.

    Article  Google Scholar 

  12. Andersen N, Bovim G, Sjaastad O. The frontotemporal peripheral nerves. Topographic variations of the supraorbital, supratrochlear and auriculotemporal nerves and their possible clinical significance. Surg Radiol Anat. 2001;23:97–104.

    Article  CAS  PubMed  Google Scholar 

  13. Hwang K, Suh M, Lee S, et al. Zygomaticotemporal nerve passage in the orbit and temporal area. J Craniofac Surg. 2004;15:209–14.

    Article  PubMed  Google Scholar 

  14. Kaminer M, Arndt K, Dover J, et al. Atlas of cosmetic surgery. Philadelphia: Elsevier Health Science; 2009. p. 65.

    Google Scholar 

  15. Ayoub C, Girard F, Boudreault D, et al. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery. Anesth Analg. 2006;103:1237–40.

    Article  CAS  PubMed  Google Scholar 

  16. Bala I, Gupta B, Bhardwaj N, Ghai B, et al. Effect of scalp block on postoperative pain relief in craniotomy patients. Anaesth Intensive Care. 2006;34:224–7.

    Article  CAS  PubMed  Google Scholar 

  17. Geze S, Yilmaz A, Tuzuner F. The effect of scalp block and local infiltration on the haemodynamic and stress response to skull-pin placement for craniotomy. Eur J Anaesthesiol. 2009;26:298–303.

    Article  CAS  PubMed  Google Scholar 

  18. Migliore M, Spagnoli D, Lorenzetti A. Perioperative pain management following neurosurgery. J Neurosurg. 2005;101:356–70.

    Google Scholar 

  19. Guilfoyle MR, Helmy A, Duane D, et al. Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 2013;116:1093–102.

    Article  PubMed  Google Scholar 

  20. Yang X, Ma J, et al. A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. BMC Anesthesiol. 2019;19:91. https://doi.org/10.1186/s12871-019-0760-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McAuliffe N, Nicholson S, et al. Awake craniotomy using dexmedetomidine and scalp blocks: a retrospective cohort study. Can J Anesth. 2018;65:1129–37. https://doi.org/10.1007/s12630-018-1178-z.

    Article  PubMed  Google Scholar 

  22. Sinatra R. Causes and Consequences of Inadequate Management of Acute Pain. Pain Med. 2010;11:1859–71.

    Article  PubMed  Google Scholar 

  23. Batoz H, Verdonck O, Pellerin C, et al. The analgesic properties of scalp infiltrations with ropivacaine after intracranial tumoral resection. Anesth Analg. 2009;109:240–4.

    Article  CAS  PubMed  Google Scholar 

  24. Greher M, Moriggl B, et al. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br J Anaesth. 2010;104(5):637–42. https://doi.org/10.1093/bja/aeq052.

    Article  CAS  PubMed  Google Scholar 

  25. Akcil E, Dilmen O, Vehid H, et al. Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clin Neurol Neurosurg. 2017;154:98–103.

    Article  PubMed  Google Scholar 

  26. Nguyen A, Girard F, Boudreault D, et al. Scalp nerve blocks decrease the severity of pain after craniotomy. Anesth Analg. 2001;93:1272–6.

    Article  CAS  PubMed  Google Scholar 

  27. Gazoni F, Pouratian N, Nemergut E. Effect of ropivacaine skull block on perioperative outcomes in patients with supratentorial brain tumors and comparison with remifentanil: a pilot study. J Neurosurg. 2008;109:44–9.

    Article  CAS  PubMed  Google Scholar 

  28. Finco G, Atzeni M, Musu M, et al. Greater occipital nerve block for surgical resection of major infiltrating lesions of the posterior scalp. Plast Reconstr Surg. 2010;125:52e–3e.

    Article  PubMed  Google Scholar 

  29. Halldin C, Paoli J, Sandberg C, et al. Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp. Br J Dermatol. 2009;160:795–800.

    Article  CAS  PubMed  Google Scholar 

  30. De Benedittis G, Lorenzetti A, Migliore M, et al. Postoperative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery. 1996;38:466–9. discussion 469–70

    PubMed  Google Scholar 

  31. Gottschalk A, Yaster M. The perioperative management of pain from intracranial surgery. Neurocrit Care. 2009;10(3):387–402.

    Article  PubMed  Google Scholar 

  32. Rocha-Filho PAS, Gherpelli JLD, de Siqueira JTT, Rabello GD. Post-craniotomy headache: characteristics, behaviour and effect on quality of life in patients operated for treatment of supratentorial intracranial aneurysms. Cephalalgia. 2008;28:41–8.

    Article  CAS  PubMed  Google Scholar 

  33. Mordhorst C, Latz B, Kerz T, Wisser G, Schmidt A, Schneider A, et al. Prospective assessment of postoperative pain after craniotomy. J Neurosurg Anesthesiol. 2010;22:202–6.

    Article  PubMed  Google Scholar 

  34. Klimek M, Ubben JFH, Ammann J, Borner U, Klein J, Verbrugge SJC. Pain in neurosurgically treated patients: a prospective observational study. J Neurosurg. 2006;104:350–9.

    Article  PubMed  Google Scholar 

  35. Irefin SA, Schubert A, Bloomfield EL, DeBoer GE, Mascha EJ, Ebrahim ZY. The effect of craniotomy location on postoperative pain and nausea. J Anesth. 2003;17:227–31.

    Article  PubMed  Google Scholar 

  36. Thibault M, Girard F, Moumdjian R, Chouinard P, Boudreault D, Ruel M. Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study. Can J Anaesth. 2007;54(7):544–8.

    Article  PubMed  Google Scholar 

  37. Flexman AM, Ng JL, Gelb AW. Acute and chronic pain following craniotomy. Curr Opin Anaesthesiol. 2010;23(5):551–7.

    Article  PubMed  Google Scholar 

  38. Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. J Neurosurg. 2007;106(2):210–6.

    Article  CAS  PubMed  Google Scholar 

  39. Glisic EK, Gardiner L, Josti L, et al. Inadequacy of headache management after subarachnoid hemorrhage. Am J Crit Care. 2016;25(2):136–43.

    Article  PubMed  Google Scholar 

  40. Ohmura S, Kawada M, Ohta T, Yamamoto K, Kobayashi T. Systemic toxicity and resuscitation in bupivacaine-, levobupivacaine-, or ropivacaine-infused rats. Anesth Analg. 2001;93:743–8.

    Article  CAS  PubMed  Google Scholar 

  41. Graf BM, Abraham I, Eberbach N, Kunst G, Stowe DF, Martin E. Differences in cardiotoxicity of bupivacaine and ropivacaine are the result of physicochemical and stereoselective properties. Anesthesiology. 2002;96:1427–34.

    Article  CAS  PubMed  Google Scholar 

  42. Scott DB, Lee A, Fagan D, Bowler GM, Bloomfield P, Lundh R. Acute toxicity of ropivacaine compared with that of bupivacaine. Anesth Analg. 1989;69:563–9.

    Article  CAS  PubMed  Google Scholar 

  43. Papangelou A, Radzik BR, et al. A review of scalp blockade for cranial surgery. J Clin Anesth. 2013;25:150–9. https://doi.org/10.1016/j.jclinane.2012.06.024.

    Article  PubMed  Google Scholar 

  44. Costello TG, Cormack JR, Hoy C, et al. Plasma ropivacaine levels following scalp block for awake craniotomy. J Neurosurg Anesthesiol. 2004;16:147–50.

    Article  PubMed  Google Scholar 

  45. Costello TG, Cormack JR, Mather LE, LaFerlita B, Murphy MA, Harris K. Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy. Br J Anaesth. 2005;94:848–51.

    Article  CAS  PubMed  Google Scholar 

  46. Hickey R, Blanchard J, Hoffman J, Sjovall J, Ramamurthy S. Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block. Can J Anaesth. 1990;37:878–82.

    Article  CAS  PubMed  Google Scholar 

  47. Hickey R, Candido KD, Ramamurthy S, et al. Brachial plexus block with a new local anaesthetic: 0.5 per cent ropivacaine. Can J Anaesth. 1990;37:732–8.

    Article  CAS  PubMed  Google Scholar 

  48. Kopacz DJ, Emanuelsson BM, Thompson GE, Carpenter RL, Stephenson CA. Pharmacokinetics of ropivacaine and bupivacaine for bilateral intercostal blockade in healthy male volunteers. Anesthesiology. 1994;81:1139–48.

    Article  CAS  PubMed  Google Scholar 

  49. Salonen MH, Haasio J, Bachmann M, Xu M, Rosenberg PH. Evaluation of efficacy and plasma concentrations of ropivacaine in continuous axillary brachial plexus block: high dose for surgical anesthesia and low dose for postoperative analgesia. Reg Anesth Pain Med. 2000;25:47–51.

    CAS  PubMed  Google Scholar 

  50. Scott DA, Emanuelsson BM, Mooney PH, Cook RJ, Junestrand C. Pharmacokinetics and efficacy of long-term epidural ropivacaine infusion for postoperative analgesia. Anesth Analg. 1997;85:1322–30.

    Article  CAS  PubMed  Google Scholar 

  51. Yang JJ, Liu J, Duan ML, Zhou ZQ, Li WY, Xu JG. Lighter general anesthesia causes less decrease in arterial pressure induced by epinephrine scalp infiltration during neurosurgery. J Neurosurg Anesthesiol. 2007;19(4):263–7.

    Article  CAS  PubMed  Google Scholar 

  52. Clark DJ. Perioperative surgical home and the integral role of pain medicine. Available at https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/painmedicine/16/9/10.1111/pme.12796/2/16-9-1666.pdf?Expires=1497560968&Signature=NxKLoxNeIKACBrEOxJPXULf6SHUSNvhP1q10K lylALp3pxNicxTS96EVo2f-o9lgkVNoGLSYEsYge8ci7j2pzFBNRlIKD7niz4o oAtd057

  53. Dijk JFM, van Wijck AJM, Kappen TH, Peelen LM, Kalkman CJ, Schuurmans MJ. The effect of a preoperative educational film on patients’ postoperative pain in relation to their request for opioids. Pain Manag Nurs. 2015;16:137–45.

    Article  PubMed  Google Scholar 

  54. Kol E, Alpar ŞE, Erdoğan A. Preoperative education and use of analgesic before onset of pain routinely for post-thoracotomy pain control can reduce pain effect and total amount of analgesics administered postoperatively. Pain Manag Nurs. 2014;15:331–9.

    Article  PubMed  Google Scholar 

  55. UCLA Neurosurgery. Value-based neurosurgery clinical report. 2015. Available at http://neurosurgery.ucla.edu/Workfiles/Site-Neurosurgery/clinical-quality-program/2015-Neurosurgery-Quality-Report2.pdf. Last accessed 1 Sept 2017.

  56. Tuere H, Sayin M, Karlikaya G, Bingol CA, Aykac B, Tuere U, et al. The analgesic effect of gabapentin as a prophylactic anticonvulsant drug on postcraniotomy pain: a prospective randomized study. Anesth Analg. 2009;109:1625–31.

    Article  CAS  Google Scholar 

  57. Misra S, Parthasarathi G, Vilanilam GC. The effect of gabapentin premedication on postoperative nausea, vomiting, and pain in patients on preoperative dexamethasone undergoing craniotomy for intracranial tumors. J Neurosurg Anesthesiol. 2013;25:386–91.

    Article  PubMed  Google Scholar 

  58. Leung JL, Sands LP, Rico M, Petersen KL, Rowbotham MC, Dahl JB, et al. Pilot clinical trial of gabapentin to decrease postoperative delirium in older surgical patients. Neurology. 2006;67:1–3.

    Article  Google Scholar 

  59. Shimony N, Amit U, Minz B, Grossman R, Dany MA, Gonen L, et al. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125:1513–22.

    Article  CAS  PubMed  Google Scholar 

  60. Misra S, Koshy T, Unnikrishnan KP, Suneel PR, Chatterjee N. Gabapentin premedication decreases the hemodynamic response to skull pin insertion in patients undergoing craniotomy. J Neurosurg Anesthesiol. 2011;23:110–7.

    Article  PubMed  Google Scholar 

  61. Markovic-Bozic J, Karpe B, Potocnik I, Jerin A, Vranic A, Novak-Jankovic V. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiol. 2016;16:18.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Prabhakar H, Singh GP, Mahajan C, Kapoor I, Kalaivani M, Anand V. Intravenous versus inhalational techniques for rapid emergence from anaesthesia in patients undergoing brain tumour surgery. In: Prabhakar H, editor. Cochrane database of systematic reviews. UK: Wiley; 2016.

    Google Scholar 

  63. Stricker PA, Kraemer FW, Ganesh A. Severe remifentanil-induced acute opioid tolerance following awake craniotomy in an adolescent. J Clin Anesth. 2009;21:124–6.

    Article  CAS  PubMed  Google Scholar 

  64. Yu EHY, Tran DHD, Lam SW, Irwin MG. Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? Anaesthesia. 2016;71:1347–62.

    Article  CAS  PubMed  Google Scholar 

  65. Vacas S, Van de Wiele B. Designing a pain management protocol for craniotomy: a narrative review and consideration of promising practices. Surg Neurol Int. 2017;8:291. http://surgicalneurologyint.com/Designing-a-pain-management-protocol-forcraniotomy:-A-narrative-review-and-consideration-of-promi

    Article  PubMed  PubMed Central  Google Scholar 

  66. Hoefnagel A, Lopez M, Smith M, Feng C, Nadler J. Intravenous acetaminophen administration in patients undergoing craniotomy—a retrospective institutional study. J Anesthes Clin Res. 2015;6:1–4.

    Google Scholar 

  67. Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery. 1994;35:1061–4. discussion 1064-5

    Article  CAS  PubMed  Google Scholar 

  68. Magni G, La Rosa I, Melillo G, Abeni D, Hernandez H, Rosa G. Intracranial hemorrhage requiring surgery in neurosurgical patients given ketorolac: a case-control study within a cohort (2001-2010). Anesth Analg. 2013;116:443–7.

    Article  PubMed  Google Scholar 

  69. Jian M, Li X, Wang A, Zhang L, Han R, Gelb AW. Flurbiprofen and hypertension but not hydroxyethyl starch is associated with post-craniotomy intracranial haematoma requiring surgery. Br J Anaesth. 2014;113:832–9.

    Article  CAS  PubMed  Google Scholar 

  70. Dolmatova EV, Imaev AA, Lubnin AY. “Scheduled” dosing of lornoxicam provides analgesia superior to that provided by “on request” dosing following craniotomy. Eur J Anaesthesiol. 2009;26:633–7.

    Article  CAS  PubMed  Google Scholar 

  71. Peng K, Jin X, Liu S, Ji F. Effect of intraoperative dexmedetomidine on post-craniotomy pain. Clin Ther. 2015;37:1114–21.e1.

    Article  CAS  PubMed  Google Scholar 

  72. Song J, Ji Q, Sun Q, Gao T, Liu K, Li L. The opioid-sparing effect of intraoperative dexmedetomidine infusion after craniotomy. J Neurosurg Anesthesiol. 2016;28:14–20.

    Article  PubMed  Google Scholar 

  73. Bekker A, Sturaitis M, Bloom M, Moric M, Golfinos J, Parker E, et al. The effect of dexmedetomidine on perioperative hemodynamics in patients undergoing craniotomy. Anesth Analg. 2008;107:1340–7.

    Article  CAS  PubMed  Google Scholar 

  74. Rajan S, Hutcherson MT, Sessler DI, Kurz A, Yang D, Ghobrial M, et al. The effects of dexmedetomidine and remifentanil on hemodynamic stability and analgesic requirement after craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol. 2016;28:282–90.

    Article  PubMed  Google Scholar 

  75. Mayberg TS, Lam AM, Matta BF, Domino KB, Winn HR. Ketamine does not increase cerebral blood flow velocity or intracranial pressure during isoflurane/nitrous oxide anesthesia in patients undergoing craniotomy. Anesth Analg. 1995;81:84–9.

    CAS  PubMed  Google Scholar 

  76. Himmelseher S, Durieux ME. Revising a dogma: ketamine for patients with neurological injury? Anesth Analg. 2005;101:524–34.

    Article  CAS  PubMed  Google Scholar 

  77. Agarwal A, Sinha PK, Pandey CM, Gaur A, Pandey CK, Kaushik S. Effect of a subanesthetic dose of intravenous ketamine and/or local anesthetic infiltration on hemodynamic responses to skull-pin placement: a prospective, placebo-controlled, randomized, double-blind study. J Neurosurg Anesthesiol. 2001;13(3):189–94.

    Article  CAS  PubMed  Google Scholar 

  78. Avidan MS, Maybrier HR, Ben AA, Jacobsohn E, Vlisides PE, Pryor KO, et al. Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Lancet. 2017;390:230.

    Article  Google Scholar 

  79. Hagan KB, Bhavsar S, Raza SM, Arnold B, Arunkumar R, Dang A, et al. Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016;24:10–6.

    Article  PubMed  Google Scholar 

  80. Nielsen RV, Siegel H, Fomsgaard JS, Andersen JDH, Martusevicius R, Mathiesen O, et al. Preoperative dexamethasone reduces acute but not sustained pain after lumbar disk surgery: a randomized, blinded, placebo-controlled trial. Pain. 2015;156:2538–44.

    Article  CAS  PubMed  Google Scholar 

  81. Samona J, Cook C, Krupa K, Swatsell K, Jackson A, Dukes C, et al. Effect of intraoperative dexamethasone on pain scores and narcotic consumption in patients undergoing total knee arthroplasty. Orthop Surg. 2017;9:110–4.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Kranke P, Jokinen J, Pace NL, Schnabel A, Hollmann MW, Hahnenkamp K, et al. Continuous intravenous perioperative lidocaine infusion for postoperative pain and recovery. Cochrane Database Syst Rev. 2015;6:CD009642.

    Google Scholar 

  83. Peng Y, Zhang W, Kass IS, Han R. Lidocaine reduces acute postoperative pain after supratentorial tumor surgery in the PACU. J Neurosurg Anesthesiol. 2016;28:309–15.

    Article  PubMed  Google Scholar 

  84. Roberts GC. Post-craniotomy analgesia: current practices in British neurosurgical centres—a survey of post-craniotomy analgesic practices. Eur J Anaesthesiol. 2005;22:328–32.

    Article  CAS  PubMed  Google Scholar 

  85. Kotak D, Cheserem B, Solth A. A survey of post-craniotomy analgesia in British neurosurgical centres: time for perceptions and prescribing to change? Br J Neurosurg. 2009;23:538–42.

    Article  CAS  PubMed  Google Scholar 

  86. Sudheer PS, Logan SW, Terblanche C, Ateleanu B, Hall JE. Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy. Anaesthesia. 2007;62:555–60.

    Article  CAS  PubMed  Google Scholar 

  87. Cold GE, Felding M. Even small doses of morphine might provoke luxury perfusion in the postoperative period after craniotomy. Neurosurgery. 1993;32:327.

    CAS  PubMed  Google Scholar 

  88. Felden L, Walter C, Harder S, Treede R-D, Kayser H, Drover D, et al. Comparative clinical effects of hydromorphone and morphine: a meta-analysis. Br J Anaesth. 2011;107:319–28.

    Article  CAS  PubMed  Google Scholar 

  89. Evers AS, Maze M, Kharasch ED. Anesthetic pharmacology: basic principles and clinical practice. 2nd ed. Cambridge: Cambridge University Press; 2011.

    Google Scholar 

  90. Ferber J, Juniewicz H, Głogowska E, Wroński J, Abraszko R, Mierzwa J. Tramadol for postoperative analgesia in intracranial surgery. Its effect on ICP and CPP. Neurol Neurochir Pol. 2000;34:70–9.

    CAS  PubMed  Google Scholar 

  91. Jeffrey HM, Charlton P, Mellor DJ, Moss E, Vucevic M. Analgesia after intracranial surgery: a double-blind, prospective comparison of codeine and tramadol. Br J Anaesth. 1999;83:245–9.

    Article  CAS  PubMed  Google Scholar 

  92. Jellish WS, Murdoch J, Leonetti JP. Perioperative management of complex skull base surgery: the anesthesiologist’s point of view. Neurosurg Focus. 2002;12:e5.

    Article  PubMed  Google Scholar 

  93. Morad AH, Winters BD, Yaster M, et al. Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial—clinical article. J Neurosurg. 2009;111(2):343–50.

    Article  PubMed  Google Scholar 

  94. Dilmen OK, Akcil EF, Tunali Y, Karabulut ES, Bahar M, Altindas F, et al. Postoperative analgesia for supratentorial craniotomy. Clin Neurol Neurosurg. 2016;146:90–5.

    Article  PubMed  Google Scholar 

  95. Na HS, An SB, Park HP, et al. Intravenous patient controlled analgesia to manage the postoperative pain in patients undergoing craniotomy. Korean J Anesthesiol. 2011;60(1):30–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  96. Stoneham MD, Cooper R, Quiney NF, et al. Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate. Anaesthesia. 1996;51(12):1176–8.

    Article  CAS  PubMed  Google Scholar 

  97. Rao GSU, Gelb AW. To use or not to use: the dilemma of NSAIDs and craniotomy. Eur J Anaesthesiol. 2009;26:625–6.

    Article  Google Scholar 

  98. Kelly KP, Janssens MC, Ross J, et al. Controversy of non-steroidal anti-inflammatory drugs and intracranial surgery: et ne nos inducas in tentationem? Br J Anaesth. 2011;107:302–5.

    Article  CAS  PubMed  Google Scholar 

  99. Walworth D, Rumana CS, Nguyen J, et al. Effects of live music therapy sessions on quality-of-life indicators, medications administered and hospital length of stay for patients undergoing elective surgical procedures for brain. J Music Ther. 2008;45:349–59.

    Article  PubMed  Google Scholar 

  100. Shin YS, Lim NY, Yun S-C, et al. A randomised controlled trial of the effects of cryotherapy on pain, eyelid oedema and facial ecchymosis after craniotomy. J Clin Nurs. 2009;18:3029–36.

    Article  PubMed  Google Scholar 

  101. An L-X, Chen X, Ren X-J, et al. Electro-acupuncture decreases postoperative pain and improves recovery in patients undergoing a supratentorial craniotomy. Am J Chin Med. 2014;42:1099–109.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shane M. Barre .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Barre, S.M., Adhikary, S.D. (2023). Acute Pain Management Protocol for Cranial Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-21291-8_17

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics