Post Craniotomy Pain Management: Beyond Opioids
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.
Current Neurology and Neuroscience Reports