Perception of pain experienced and adequacy of analgesia following elective craniotomy

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

“…Five of 60 had such severe pain that they required rescue analgesia and were withdrawn from the study. The range of pain scores recorded were similar to those reported by Graham et al [6] with a trend to lower scores in the morphine and codeine groups during the duration of the study but significant, residual pain in the tramadol group.…”

“…Ten percent of craniotomy patients had severe postoperative pain or required more than 10 mg of morphine in the postanaesthetic care unit. Most recent reports have suggested that pain is a greater problem than previously considered, with 40-60% of patients having moderate to excruciating pain [3][4][5][6]. A recent review article [7] identified acute postoperative pain as an important clinical problem which has been comparatively neglected, and found that chronic pain resulting from intracranial surgery has received scant attention, with a paucity of data on its incidence and management.…”

Postoperative pain, nausea and vomiting in neurosurgical patients

“…Although craniotomy pain is generally less severe than the pain of extracranial surgery [10,11], more than 50% of craniotomy patients experience postoperative pain of moderate or severe intensity [3][4][5]. Although surgeons believe that infratentorial craniotomy is associated with more pain than supratentorial craniotomy [4], there is no firm supporting evidence.…”

“…Cranial neurosurgical patients are known to suffer from moderately severe postoperative pain [3][4][5] and high rates of PONV [6][7][8], and spinal surgery patients, particularly those undergoing fusion or scoliosis surgery, may have major issues preoperatively and postoperatively, and consequently have significant functional impairment [9]. Whilst a massive literature exists about the treatment of postoperative pain and PONV in other types of surgical patients, rather less has been published about treatment of these problems following neurosurgery.…”

A review of the efficacy and safety of opioid analgesics post‐craniotomy*

“…Other studies have demonstrated a lack of analgesic efficacy from tramadol. Graham et al (1999) in a randomized, double-blind trial comparing the analgesic efficacy of IM tramadol and codeine on post-craniotomy patients had to conclude the study prematurely because of 49% of patients' experiencing severe pain and requiring rescue analgesia. No significant difference between codeine and tramadol was found with both, providing inadequate analgesia.…”