Anesth Pain Med.  2016 Oct;11(4):327-336. 10.17085/apm.2016.11.4.327.

The treatment of postcraniotomy pain

• Min J

• KMID: 2358326
• DOI: http://doi.org/10.17085/apm.2016.11.4.327

Abstract

Postoperative pain is under-treated, and especially postcraniotomy pain is under-treated due to the fear of missing postoperative neurologic complications, and the fear of increased intracranial pressure secondary to elevated arterial carbon dioxide tension caused by respiratory depression. However, it continues to be commonly observed, is frequently severe, and if unrelieved, it may cause distress for the neurosurgical patients and serious complications in the operated brains. Many contributing factors affect postcraniotomy pain, including anatomical, surgical, anesthetic, and patient related factors. Diverse modalities are used for relieving the pain such as certain surgical techniques, nerve and scalp blocks with local anesthetics, many drugs - nonsteroidal anti-inflammatory drugs, gabapentinoids, N-methyl-D-aspartate antagonists, and opioids, but individually none of these modalities have been proved to be the best and universally applicable. For proper treatment and management of postcraniotomy pain, it is necessary to have a patient oriented, evidence-based, well-organized guideline for neuroanesthesiologists, neurosurgeons, and postcraniotomy patients.

Keyword

Craniotomy; Postoperative pain

MeSH Terms

Analgesics, Opioid
Anesthetics, Local
Brain
Carbon Dioxide
Craniotomy
Humans
Intracranial Pressure
N-Methylaspartate
Neurosurgeons
Pain, Postoperative
Respiratory Insufficiency
Scalp
Analgesics, Opioid
Anesthetics, Local
Carbon Dioxide
N-Methylaspartate

Figure

• 

  Fig. 1 Intracranial innervation of the dura is provided by branches from all three divisions of the trigeminal nerve and the first three spinal nerves (from reference 22).

• 

  Fig. 2 Innervation of the scalp and underlying muscles (from reference 22).

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