Enhanced Recovery After Surgery (ERAS) for Patients Undergoing Craniotomy: A Systematic Review

Kapoor, Indu; Mahajan, Charu; Prabhakar, Hemanshu

doi:10.1097/ana.0000000000000764

Cited by 13 publications

(10 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ERAS protocol has been introduced for patients with brain tumors, but there is no generally accepted standard protocol or guideline. 20 , 36 This is partly due to the limited data; therefore, further clinical studies are needed. Furthermore, studies on the importance of adherence to protocols have not yet been reported.…”

Section: Discussionmentioning

confidence: 99%

The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies

Kaewborisutsakul

Kitsiripant

Kaewsridam

et al. 2023

World Neurosurgery: X

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies

Kaewborisutsakul

Kitsiripant

Kaewsridam

et al. 2023

World Neurosurgery: X

View full text Add to dashboard Cite

“…86 At present, studies investigating ERAS protocols in cranial surgery remain scarce and only three RCTs could be included in two recent systematic reviews. 87,88 These studies demonstrate the feasibility of enhanced recovery after brain surgery, but the benefits need to be clarified.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review identified 17 complete ERAS protocols published for elective craniotomy, demonstrating positive results in different outcomes such as postoperative pain control, reduced length of stay and costs 86 . At present, studies investigating ERAS protocols in cranial surgery remain scarce and only three RCTs could be included in two recent systematic reviews 87,88 . These studies demonstrate the feasibility of enhanced recovery after brain surgery, but the benefits need to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Pain management after elective craniotomy

Mestdagh,

Lavand’homme,

Pirard

et al. 2023

European Journal of Anaesthesiology

View full text Add to dashboard Cite

BACKGROUND Pain after craniotomy can be intense and its management is often suboptimal. OBJECTIVES We aimed to evaluate the available literature and develop recommendations for optimal pain management after craniotomy. DESIGN A systematic review using procedure-specific postoperative pain management (PROSPECT) methodology was undertaken. DATA SOURCES Randomised controlled trials and systematic reviews published in English from 1 January 2010 to 30 June 2021 assessing pain after craniotomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. ELIGIBILITY CRITERIA Each randomised controlled trial (RCT) and systematic review was critically evaluated and included only if met the PROSPECT requirements. Included studies were evaluated for clinically relevant differences in pain scores, use of nonopioid analgesics, such as paracetamol and NSAIDs, and current clinical relevance. RESULTS Out of 126 eligible studies identified, 53 RCTs and seven systematic review or meta-analyses met the inclusion criteria. Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol, NSAIDs, intravenous dexmedetomidine infusion, regional analgesia techniques, including incision-site infiltration, scalp nerve block and acupuncture. Limited evidence was found for flupirtine, intra-operative magnesium sulphate infusion, intra-operative lidocaine infusion, infiltration adjuvants (hyaluronidase, dexamethasone and α-adrenergic agonist added to local anaesthetic solution). No evidence was found for metamizole, postoperative subcutaneous sumatriptan, pre-operative oral vitamin D, bilateral maxillary block or superficial cervical plexus block. CONCLUSIONS The analgesic regimen for craniotomy should include paracetamol, NSAIDs, intravenous dexmedetomidine infusion and a regional analgesic technique (either incision-site infiltration or scalp nerve block), with opioids as rescue analgesics. Further RCTs are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

show abstract

“…3,4 Opioids prescribed for postcraniotomy pain management are associated with intrinsic side effects and may affect neurological assessments by obscuring early signs of intracranial complications. 5 Strategies that rely on nonopioid analgesics are warranted, especially in the era of enhanced recovery after surgery (ERAS), 6 which has been associated with benefits in postoperative pain management, length of hospital stay, and cost reduction in patients undergoing craniotomy. [6][7][8] Scalp nerve block (SNB) and scalp infiltration (SI) are unique alternatives to opioid analgesics in craniotomy.…”

mentioning

confidence: 99%

“…5 Strategies that rely on nonopioid analgesics are warranted, especially in the era of enhanced recovery after surgery (ERAS), 6 which has been associated with benefits in postoperative pain management, length of hospital stay, and cost reduction in patients undergoing craniotomy. [6][7][8] Scalp nerve block (SNB) and scalp infiltration (SI) are unique alternatives to opioid analgesics in craniotomy. SNB, initially described by Girvin, 9 involves blocking the superficial sensory nerves of the scalp at multiple sites, whereas SI involves subcutaneous infiltration of local anesthetics at the surgical incision site.…”

mentioning

confidence: 99%

Scalp Nerve Block, Local Anesthetic Infiltration, and Postoperative Pain After Craniotomy: A Systematic Review and Network Meta-analysis of Randomized Trials

Luo

Zhao

Deng

et al. 2022

Journal of Neurosurgical Anesthesiology

View full text Add to dashboard Cite

The most efficacious methods for controlling postoperative pain in craniotomy remain unknown. A systematic review and network meta-analysis were performed to compare the efficacies of different strategies of scalp nerve block (SNB), scalp infiltration (SI), and control in patients undergoing craniotomy. MEDLINE, Embase, and CENTRAL databases were searched for randomized controlled trials. The primary outcome was postoperative 24-hour pain score, and the secondary outcome was opioid consumption within the first 24 hour after surgery. The effect was estimated using the between-group mean difference and ranked using the surface under the cumulative ranking curve (SUCRA) score. Twenty-four randomized trials were identified for inclusion. SNB using ropivacaine reduced postoperative 24-hour pain score when compared with control (mean difference [95% credible interval], -2.04 [-3.13, -0.94]; low quality), and when compared with SI using ropivacaine (-1.77 [-3.04, -0.51]; low quality) or bupivacaine (-1.96 [-3.65, -0.22]; low quality). SNB using ropivacaine was likely the most efficacious method for pain control (SUCRA, 91%), and also reduced opioid consumption within the first postoperative 24 hours as compared with control (mean difference [95% credible interval], -11.91 [-22.42, -1.4]; low quality). SNB using bupivacaine, lidocaine, and epinephrine combined, and SNB using ropivacaine, were likely the most efficacious methods for opioid consumption reduction (SUCRA, 88% and 80%, respectively). In summary, different methods of SNB / SI seem to have different efficacies after craniotomy. SNB using ropivacaine may be superior to other methods for postcraniotomy pain control; however, the overall quality of evidence was low.

show abstract

Enhanced Recovery After Surgery (ERAS) for Patients Undergoing Craniotomy: A Systematic Review

Cited by 13 publications

References 10 publications

The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies

The influence of enhanced recovery after surgery protocol adherence in patients undergoing elective neuro-oncological craniotomies

Pain management after elective craniotomy

Scalp Nerve Block, Local Anesthetic Infiltration, and Postoperative Pain After Craniotomy: A Systematic Review and Network Meta-analysis of Randomized Trials

Contact Info

Product

Resources

About