Even Small Doses of Morphine Might Provoke ???Luxury Perfusion??? in the Postoperative Period after Craniotomy

Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial

“…20 Furthermore, opioids, even when administered in therapeutic doses, may depress minute ventilation, leading to hypercapnia, increased in tracerebral blood volume, and potentially increased intra cranial pressure and cerebral edema. 4 Moreover, why ex pose a patient to these risks when there is a presumed lack of need? Decades of training and anecdote have reinforced a widely held belief that patients do not experience intense pain following intracranial surgery, a belief supported by the fact that surgery on the brain parenchyma per se is not painful.…”

Prospective evaluation of pain and analgesic use following major elective intracranial surgery

“…Furthermore, opioids, even when administered in therapeutic doses, may depress minute ventilation, leading to hypercapnia, increased intracerebral blood volume, and potentially increased intracranial pressure and cerebral edema. 2 Although decades of training and anecdotal evidence have reinforced a widely held belief that patients do not experience intense pain following intracranial surgery-a belief supported by the fact that surgical treatment of the brain parenchyma per se is not painful-there are relatively few studies in which the incidence and severity of pain have actually been assessed in this patient population.…”

Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy*

“…Currently, postoperative analgesia continues to be largely treated with intramuscular codeine phosphate because of concerns about the association between opioid analgesia and respiratory depression [8]. A postal questionnaire survey in 2005 [9] showed that 78% of centres in the UK were still using codeine for postoperative analgesia.…”