Acute and chronic pain following craniotomy

Flexman, Alana M.; Ng, Julie L W; Gelb, Adrian W.

doi:10.1097/aco.0b013e32833e15b9

Cited by 121 publications

(107 citation statements)

References 67 publications

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“…Acute postcraniotomy headache appears to include components of site-of-injury and tension-type headaches [2] , [9]. We found that preoperative administration of just a single dose of the non-steroidal inflammatory agent diclofenac slightly reduced both the incidence and the severity of acute postcraniotomy headache.…”

Section: Discussionmentioning

confidence: 65%

“…Nociception, in turn, provokes central sensitization, windup, and activation of brain structures involved in pain perception [9]. Reducing the initial nociceptive stimulus may thus reduce post-procedural pain which is the basis for preemptive analgesia, a concept introduced by Wall in the late 1980's [15].…”

Section: Discussionmentioning

confidence: 99%

“…Most previous clinical studies assessed the effect of intraoperative and postoperative treatments, such as local infiltration of the surgical site before craniotomy and administration of different analgesics after craniotomies [8] , [9] [10].…”

Section: Introductionmentioning

confidence: 99%

“…The past decade has seen publication of many studies assessing the efficacy and safety of preoperative, intraoperative, and postoperative treatments. Nonetheless, two recent systematic reviews concluded that "no firm recommendations on analgesia following craniotomy can be given" [8] , [9].…”

Section: Introductionmentioning

confidence: 99%

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A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

Molnár¹,

Simon²,

Kazup³

et al. 2015

Journal of the Neurological Sciences

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A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: a single center, randomized, blinded trial This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. KTIA_13_NAP-A-II/5. None of the authors has a personal financial interest in this research. A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 2 AbstractObjective: Postcraniotomy headache causes considerable pain and can be difficult to treat. We therefore tested the hypothesis that a single 100-mg preoperative dose of diclofenac reduces the intensity of postcraniotomy headache, and reduces analgesic requirements.Methods: 200 patients having elective craniotomies were randomly assigned to diclofenac (n=100) or control (n=100). Pain severity was assessed by an independent observer using a 10-cm-long visual analogue scale the evening of surgery, and on the 1st and 5th postoperative days. Analgesics given during the first five postoperative days were converted to intramuscular morphine equivalents.Results were compared using Mann-Whitney-tests; P<0.05 was considered statistically significant.Results: Baseline and surgical characteristics were comparable in the diclofenac and control groups. Visual analogue pain scores were slightly, but significantly lower with diclofenac at all times (means and 95% confidence intervals): the evening of surgery, 2.47 (1.8-3.1) vs. 4. 37(5.0-3.7), (P<0.001); first postoperative day, 3.98 (3.4-4.6) vs.5.6 (4.9-6.2) cm (P<0.001) and 5th postoperative day: 2.8 (2.2-3.4) vs. 4.0 ± (3.3-4.7) cm (P = 0.013). Diclofenac reduced systemic analgesic requirements over the initial five postoperative days (mean and 95% CI): 3.3 (2.6 -3.9) vs. 4.3 (3.5-5.1) mg morphine equivalents (p<0.05). Conclusions: Preoperative diclofenac administration reduces postcraniotomyheadache and postoperative analgesic requirements -a benefit that persisted throughout five postoperative days.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A single preoperative dose of diclofenac reduces the intensity of acute postcraniotomy headache and decreases analgesic requirements over five postoperative days in adults: A single center, randomized, blinded trial

Molnár¹,

Simon²,

Kazup³

et al. 2015

Journal of the Neurological Sciences

View full text Add to dashboard Cite

show abstract

“…Occurrence of pain in the postoperative period after brain surgery is sometime overlooked [5,[10][11][12]. Prevention of this serious complication is mostly associated with appropriate perioperative management, including the use of local anesthetics for scalp block in the intraoperative period, and adequate nociceptive therapeutic regimen.…”

Section: Painmentioning

confidence: 99%