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

Gottschalk, Allan; Berkow, Lauren; Stevens, Robert; Mirski, Marek A.; Thompson, Richard E.; White, Elizabeth; Weingart, Jon; Long, Donlin M.; Yaster, Myron

doi:10.3171/jns.2007.106.2.210

Cited by 167 publications

(134 citation statements)

References 25 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…13 In concordance with other studies, we also showed that infratentorial surgery was associated with the greatest opioid consumption. 14,15 In the present study, we did not obtain higher NRS scores compared with our similarly designed previous study in the supratentorial population. 6 However, the need for analgesia in the postoperative period was much greater in the present study than in our previous study (553 mg ± 400 vs 332 mg ± 230, respectively; P = 0.009).…”

Section: Discussioncontrasting

confidence: 46%

“…5,[13][14][15][16] In a previous retrospective study, we found that 76% of craniotomy patients experience moderate to severe pain during this time period. 13 In concordance with other studies, we also showed that infratentorial surgery was associated with the greatest opioid consumption.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7][8][9][10][11][12] The focus of these studies was on the evaluation of pain in supratentorial surgery, whereas patients undergoing infratentorial or occipital neurosurgery report more severe pain with increased opioid consumption. [13][14][15][16] The superficial cervical plexus block (SCPB) blocks the branches of the occipital nerves and may be a good alternative to opioid analgesia in this patient population. 17 We designed this randomized controlled double-blind study to compare the quality of transitional analgesia provided by SCPB with that provided by intravenous morphine following general anesthesia consisting of remifentanil and sevoflurane for infratentorial or occipital craniotomy.…”

Section: Résumémentioning

confidence: 99%

See 2 more Smart Citations

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Girard

Quentin

Charbonneau

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Background In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanilbased anesthesia for infratentorial or occipital craniotomy. Methods In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mgÁkg -1 iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine. Results Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups. Conclusion Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies. RésuméContexte Dans le cadre de cette e´tude, nous avons compare´la qualite´de l'analge´sie transitionnelle produite par un bloc bilate´ral du plexus cervical superficiel (SCPB) ou par la morphine a`la suite d'une anesthe´sie au re´mifentanil lors d'une craniotomie sous-tentorielle ou occipitale. Méthode Dans cette e´tude randomise´e et contrôle´e en double aveugle, 30 patients ayant subi une craniotomie sous-tentorielle ou occipitale ont e´te´divise´s ale´atoirement en deux groupes: le groupe morphine (morphine 0,1 mgÁkg -1 intraveineuse apre`s la fermeture de la dure-me`re et un SCPB effectue´avec 20 mL de solution sale´e à 0,9 % a`la fin de la chirurgie) ou le groupe bloc (10 mL de solution sale´e à 0,9 % intraveineuse au lieu de la morphine apre`s la fermeture de la dure-me`re, et un SCPB effectueá vec 20 mL d'un me´lange 1:1 de bupivacaı¨ne a`0,5 % et de lidocaı¨ne a`2 % à la fin de la chirurgie). La douleur postope´ratoire a e´te´mesure´e à une, deux, quatre, huit, 12, 16 et 24 h a`l'aide d'une e´chelle d'e´valuation nume´rique

show abstract

Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Girard

Quentin

Charbonneau

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…However, recent surveys have shown that patients may have significant pain in the early phase after intracranial surgery. In one survey, 69% of patients reported moderate to severe pain on the first postoperative day (Gottschalk et al, 2007 Level IV). These findings are in line with another study that found incidences of 56% moderate and 25% severe pain (Thibault et al, 2007 Level IV).…”

Section: Cranial Neurosurgerymentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

View full text Add to dashboard Cite

Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

show abstract

“…Subsequent studies have shown that the incidence of PCH is underestimated both by physicians and nurses [5,6] , [7]. The past decade has seen publication of many studies assessing the efficacy and safety of preoperative, intraoperative, and postoperative treatments.…”

Section: Introductionmentioning

confidence: 99%

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

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.

show abstract

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

Abstract: In contrast to prevailing assumptions, the study findings reveal that most patients undergoing elective major intracranial surgery will experience moderate to severe pain for the first 2 days after surgery and that this pain is often inadequately treated.

Cited by 167 publications

References 25 publications

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

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

Contact Info

Product

Resources

About