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Medicina
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Craniotomy: Strategies for Prevention and Treatment of Pain
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Craniotomy: Strategies for Prevention and Treatment of Pain

A special issue of Medicina (ISSN 1648-9144).

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 5344

Special Issue Editors

Dr. Emanuele La Corte

E-Mail Website
Guest Editor
Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
Interests: pediatric neurosurgery; skull base surgery; pituitary adenoma; craniopharyngioma; chordoma
Dr. Raffaele Aspide

E-Mail Website
Guest Editor
IRCCS Istituto delle Scienze Neurologiche di Bologna, Anesthesia and Neurointensive Care Unit, Bologna, Italy
Interests: acquired brain injury; neuroanesthesia; neurocritical care; optic nerve sheath diameter; Doppler ultrasonography; neuro monitoring
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Special Issue Information

Dear Colleagues,

Pain and headaches are common and, sometimes, neglected complications after a neurosurgical craniotomy procedure, although they are well recognized according to the third edition of the International Classification of Headache Disorders (ICHD-3). Postcraniotomy pain has a significant impact on the quality of life of neurosurgical patients. Despite different pharmacological approaches, strategic changes due to side effects, drug tolerance, opioid crises and the spread of nonpharmacological treatments, even the use of infiltrative therapies, the chronicization of this type of neuropathic pain remains widely without solutions. There is a need for a critical appraisal and clinical trials to adequately evaluate the prophylactic and actual relief treatments for postcraniotomy pain.

The goal of the present Special Issue is to collect innovative research articles and updated reviews in the fields of neurosurgical and neuroanesthesiologic research on postcraniotomy pain. Authors are welcome to submit original articles, clinical trials, scoping and systematic reviews, perspectives and retrospectives, opinions, case reports and clinical series focusing on the current state-of-the-art and perspectives of strategies to prevent and treat postcraniotomy pain in the following topics:

  • Elective and urgent neurosurgical craniotomy procedures;
  • Oncological, vascular, trauma, pediatric and functional neurosurgery procedures;
  • Preoperative and perioperative pain control;
  • Multidisciplinary and multimodal treatment approaches;
  • Pharmacological and invasive treatments for pain relief;
  • Acute postoperative and chronic neuropathic pain control after craniotomy;
  • Infiltrative scalp block to prevent postoperative and intraoperative pain in general anesthesia and local–regional anesthesia (i.e., awake surgery procedures);
  • Experimental studies at the cellular and epigenetic levels, including in animal models.

Dr. Emanuele La Corte
Dr. Raffaele Aspide
Guest Editors

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Keywords

  • craniotomy
  • postoperative pain
  • scalp nerve block
  • analgesia
  • intravenous
  • narcotic
  • neurocritical care
  • neurosurgery
  • pain
  • visual analog scale

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Published Papers (2 papers)

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10 pages, 547 KiB  
Article
The Prevalence and Factors Associated with the Prescription of Opioids for Head/Neck Pain after Elective Craniotomy for Tumor Resection/Vascular Repair: A Retrospective Cohort Study
by Wei-Yun Wang, Varadaraya Satyanarayan Shenoy, Christine T. Fong, Andrew M. Walters, Laligam Sekhar, Michele Curatolo, Monica S. Vavilala and Abhijit V. Lele
Medicina 2023, 59(1), 28; https://doi.org/10.3390/medicina59010028 - 23 Dec 2022
Cited by 1 | Viewed by 1691
Abstract
Background and objective: There is no report of the rate of opioid prescription at the time of hospital discharge, which may be associated with various patient and procedure-related factors. This study examined the prevalence and factors associated with prescribing opioids for head/neck pain [...] Read more.
Background and objective: There is no report of the rate of opioid prescription at the time of hospital discharge, which may be associated with various patient and procedure-related factors. This study examined the prevalence and factors associated with prescribing opioids for head/neck pain after elective craniotomy for tumor resection/vascular repair. Methods: We performed a retrospective cohort study on adults undergoing elective craniotomy for tumor resection/vascular repair at a large quaternary-care hospital. We used univariable and multivariable analysis to examine the prevalence and factors (pre-operative, intraoperative, and postoperative) associated with prescribing opioids at the time of hospital discharge. We also examined the factors associated with discharge oral morphine equivalent use. Results: The study sample comprised 273 patients with a median age of 54 years [IQR 41,65], 173 females (63%), 174 (63.7%) tumor resections, and 99 (36.2%) vascular repairs. The majority (n = 264, 96.7%) received opioids postoperatively. The opiate prescription rates were 72% (n = 196/273) at hospital discharge, 23% (19/83) at neurosurgical clinical visits within 30 days of the procedure, and 2.4% (2/83) after 30 days from the procedure. The median oral morphine equivalent (OME) at discharge use was 300 [IQR 175,600]. Patients were discharged with a median supply of 5 days [IQR 3,7]. On multivariable analysis, opioid prescription at hospital discharge was associated with pre-existent chronic pain (adjusted odds ratio, aOR 1.87 [1.06,3.29], p = 0.03) and time from surgery to hospital discharge (compared to patients discharged within days 1–4 postoperatively, patients discharged between days 5–12 (aOR 0.3, 95% CI [0.15; 0.59], p = 0.0005), discharged at 12 days and later (aOR 0.17, 95% CI [0.07; 0.39], p < 0.001)). There was a linear relationship between the first 24 h OME (p < 0.001), daily OME (p < 0.001), hospital OME (p < 0.001), and discharge OME. Conclusions: This single-center study finds that at the time of hospital discharge, opioids are prescribed for head/neck pain in as many as seven out of ten patients after elective craniotomy. A history of chronic pain and time from surgery to discharge may be associated with opiate prescriptions. Discharge OME may be associated with first 24-h, daily OME, and hospital OME use. Findings need further evaluation in a large multicenter sample. The findings are important to consider as there is growing interest in an early discharge after elective craniotomy. Full article
(This article belongs to the Special Issue Craniotomy: Strategies for Prevention and Treatment of Pain)
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20 pages, 6302 KiB  
Systematic Review
Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials
by Giorgio Fiore, Edoardo Porto, Mauro Pluderi, Antonella Maria Ampollini, Stefano Borsa, Federico Giuseppe Legnani, Davide Giampiccolo, Anna Miserocchi, Giulio Andrea Bertani, Francesco DiMeco and Marco Locatelli
Medicina 2023, 59(5), 831; https://doi.org/10.3390/medicina59050831 - 24 Apr 2023
Cited by 3 | Viewed by 2856
Abstract
Background and Objective: To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. Material and Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [...] Read more.
Background and Objective: To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. Material and Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated the effectiveness of pharmacological treatments for preventing post-operative pain in adults (aged 18 years or older) undergoing craniotomies. The main outcome measures were represented by the mean differences in validated pain intensity scales administered at 6 h, 12 h, 24 h and 48 h post-operatively. The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the RoB2 revised tool, and the certainty of evidence was assessed according to the GRADE guidelines. Results: In total, 3359 records were identified through databases and registers’ searching. After study selection, 29 studies and 2376 patients were included in the meta-analysis. The overall risk of bias was low in 78.5% of the studies included. The pooled estimates of the following drug classes were provided: NSAIDs, acetaminophen, local anesthetics and steroids for scalp infiltration and scalp block, gabapentinoids and agonists of adrenal receptors. Conclusions: High-certainty evidence suggests that NSAIDs and acetaminophen may have a moderate effect on reducing post-craniotomy pain 24 h after surgery compared to control and that ropivacaine scalp block may have a bigger impact on reducing post-craniotomy pain 6 h after surgery compared to control. Moderate-certainty evidence indicates that NSAIDs may have a more remarkable effect on reducing post-craniotomy pain 12 h after surgery compared to control. No moderate-to-high-certainty evidence indicates effective treatments for post-craniotomy pain prevention 48 h after surgery. Full article
(This article belongs to the Special Issue Craniotomy: Strategies for Prevention and Treatment of Pain)
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