Multimodal analgesia in neurosurgery: a narrative review

Postgrad Med. 2021 Dec 7. doi: 10.1080/00325481.2021.2015221. Online ahead of print.ABSTRACTPain following brain surgery can compromise the result of surgery. Several pharmacological interventions have been used to prevent postoperative pain in adults undergoing brain surgery. Pain following craniotomy is considered to be moderate to severe during the first two post-operative days. Opioids have been historically the mainstay and are the current prominent strategy for pain treatment. They produce analgesia, but may alter respiratory, cardiovascular, gastrointestinal and neuroendocrine functions. All these side effects may affect the normal postoperative course of craniotomy, by affecting neurological function and increasing intracranial pressure. Therefore their use in neurosurgery is limited and opioids are used in case of strict necessity or as rescue medication. In addition to opioids, drugs with differing mechanisms of actions target pain pathways resulting in additive and/or synergistic effects. Some of these agents inclde acetaminophen/non-steroidal anti-inflammatory drugs (NSAIDs), alpha 2 agonists, NMDA receptor antagonists, gabapentinoids, and local anesthesia techniques. Multimodal analgesia should be a balance between adequate analgesia and less drug induced sedation, respiratory depression, hypercapnia, nausea and vomiting, which may increase intracranial pressure. Non-opioid analgesics can be an useful pharmacological alternative in multimodal regimes to manage po...
Source: Postgraduate Medicine - Category: Internal Medicine Authors: Source Type: research