ACUTE PAIN AFTER CRANIOTOMY - PEARLS💎

🗡Severe pain ( > 4 on a 0–10 scale) is commonly experienced during the first 48h with an incidence of nearly 70% on the first postoperative day and 48% on the second postoperative day 

🗡 Women, younger patients and patients who required opioid analgesics preoperatively report significantly greater levels of postoperative pain

🗡 Infratentorial procedures are associated with more severe pain than supratentorial procedures        

🗡Reduced pain has been reported with a translabyrinthine as opposed to a suboccipital approach for acoustic neuroma resection 

🗡The amount of muscle damage from resection of the temporalis and posterior cervical muscles may also influence the degree of postoperative pain 

🗡Preoperative Gabapentin, parecoxib and lornoxicam may reduce opiate-induced hyperalgesia 

🗡the addition of ondansetron to PCA has not been shown to reduce nausea and vomiting after craniotomy 

🗡evidence suggests that NSAIDs should be stopped prior to neurosurgery and avoided in patients with cardiovascular disease. 

🗡  Gabapentin given 7 days prior to surgery results in significantly lower postoperative pain scores and morphine consumption during the first 48 postoperative hours compared to phenytoin

🗡  Preoperative use of nerve blocks or local anesthetic infiltration reduces intraoperative analgesic requirements and may help to reduce pain in the early postoperative period

#craniotomy , #painmanagement, #painaftercraniotomy , #analgesia , #anesthesia ,#neurosurgery 

(Ref: Acute and chronic pain following craniotomy Alana M. Flexman, Julie L. Ng and Adrian W. Gelb, Current Opinion in Anaesthesiology 2010, 23:551–557)