Pain management after elective craniotomy : A systematic review with procedure-specific postoperative pain management (PROSPECT) recommendations
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
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| Enthalten in: |
European journal of anaesthesiology - 40(2023), 10 vom: 01. Okt., Seite 747-757 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Mestdagh, François P [VerfasserIn] |
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| Links: |
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| Themen: |
362O9ITL9D |
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| Anmerkungen: |
Date Completed 11.09.2023 Date Revised 13.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/EJA.0000000000001877 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM35918877X |
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| 041 | |a eng | ||
| 100 | 1 | |a Mestdagh, François P |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pain management after elective craniotomy |b A systematic review with procedure-specific postoperative pain management (PROSPECT) recommendations |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 11.09.2023 | ||
| 500 | |a Date Revised 13.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care. | ||
| 520 | |a BACKGROUND: Pain after craniotomy can be intense and its management is often suboptimal | ||
| 520 | |a OBJECTIVES: We aimed to evaluate the available literature and develop recommendations for optimal pain management after craniotomy | ||
| 520 | |a DESIGN: A systematic review using procedure-specific postoperative pain management (PROSPECT) methodology was undertaken | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Dexmedetomidine |2 NLM | |
| 650 | 7 | |a 67VB76HONO |2 NLM | |
| 650 | 7 | |a Acetaminophen |2 NLM | |
| 650 | 7 | |a 362O9ITL9D |2 NLM | |
| 650 | 7 | |a Analgesics |2 NLM | |
| 650 | 7 | |a Anti-Inflammatory Agents, Non-Steroidal |2 NLM | |
| 700 | 1 | |a Lavand'homme, Patricia M |e verfasserin |4 aut | |
| 700 | 1 | |a Pirard, Géraldine |e verfasserin |4 aut | |
| 700 | 1 | |a Joshi, Girish P |e verfasserin |4 aut | |
| 700 | 1 | |a Sauter, Axel R |e verfasserin |4 aut | |
| 700 | 1 | |a Van de Velde, Marc |e verfasserin |4 aut | |
| 700 | 0 | |a PROSPECT Working Group∗ of the European Society of Regional Anaesthesia and Pain Therapy (ESRA) |e verfasserin |4 aut | |
| 700 | 1 | |a Joshi, G P |e investigator |4 oth | |
| 700 | 1 | |a Pogatzki-Zahn, E |e investigator |4 oth | |
| 700 | 1 | |a Van de Velde, M |e investigator |4 oth | |
| 700 | 1 | |a Bonnet, M P |e investigator |4 oth | |
| 700 | 1 | |a Kehlet, H |e investigator |4 oth | |
| 700 | 1 | |a Bonnet, F |e investigator |4 oth | |
| 700 | 1 | |a Rawal, N |e investigator |4 oth | |
| 700 | 1 | |a Delbos, A |e investigator |4 oth | |
| 700 | 1 | |a Lavand’homme, P |e investigator |4 oth | |
| 700 | 1 | |a Beloeil, H |e investigator |4 oth | |
| 700 | 1 | |a Raeder, J |e investigator |4 oth | |
| 700 | 1 | |a Sauter, A |e investigator |4 oth | |
| 700 | 1 | |a Albrecht, E |e investigator |4 oth | |
| 700 | 1 | |a Lirk, P |e investigator |4 oth | |
| 700 | 1 | |a Freys, S |e investigator |4 oth | |
| 700 | 1 | |a Lobo, D |e investigator |4 oth | |
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