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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Pain management in post-craniotomy patients: a survey of canadian neurosurgeons.
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Pain management in post-craniotomy patients: a survey of canadian neurosurgeons.

机译：开颅手术后患者的疼痛处理：加拿大神经外科医师调查。

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INTRODUCTION: Despite the growing recognition for analgesic needs in post-craniotomy patients, this remains a poorly studied area in neurological surgery. The class and regimen of analgesia that is most suitable for these patients remains controversial. The objective of this study is to examine the current beliefs and practices of Canadian neurosurgeons when managing post-craniotomy pain. METHODS: A survey was sent to all practicing Canadian neurosurgeons to examine the following aspects of analgesia in craniotomy patients: type of analgesics used, common side effects encountered, satisfaction with current regimen and the rationale for their practice. RESULTS: Of 156 potential respondents, 103 neurosurgeons (66%) completed the survey. Codeine (59%) was the most prescribed first line analgesic followed by morphine (38%). The use of a second-line opioid was significantly higher among codeine prescribers compared to morphine, 53% compared to 28% (p < 0.001). Nausea, constipation and neurologic depression were reported as common side effects by 76%, 66% and 27% of respondents respectively. Of the respondents, 90% reported a high level of satisfaction with their current choice of analgesia; nonetheless, they predominantly described their practice as personal preference or protocol driven rather than evidence-based. CONCLUSIONS: Codeine - a weak opioid - is the most common first-line analgesic prescribed to craniotomy patients. This practice is associated with substantially increased reliance on potent opioids for rescue analgesia. Whether novel regimens can provide optimal pain control while minimizing neurologic and gastrointestinal side effects remains to be addressed by future trials.
机译：简介：尽管颅骨切开术后患者对止痛药的认识日益增长，但这仍然是神经外科领域研究较少的领域。最适合这些患者的镇痛方法和方案仍存在争议。这项研究的目的是检查在治疗颅骨切开术后疼痛时加拿大神经外科医生的当前观念和做法。方法：向所有在职的加拿大神经外科医师进行了调查，以检查颅骨切开术患者的以下镇痛情况：所使用的镇痛剂类型，遇到的常见副作用，对当前治疗方案的满意程度以及其实施的理由。结果：在156位潜在的受访者中，有103位神经外科医生（66％）完成了调查。可待因（59％）是处方最广泛的一线镇痛药，其次是吗啡（38％）。与吗啡相比，可待因处方者中二线阿片类药物的使用率显着更高，相比之下，吗啡的使用率是53％到28％（p <0.001）。据报告，分别有76％，66％和27％的受访者认为恶心，便秘和神经系统抑郁是常见的副作用。在受访者中，有90％的人对他们目前的镇痛选择表示满意;然而，他们主要将自己的行为描述为个人喜好或协议驱动，而不是循证的。结论：可待因-一种弱阿片类药物-是开颅手术患者最常用的一线镇痛药。这种做法会大大增加对有效阿片类药物的依赖，以进行抢救性镇痛。新方案是否可以提供最佳的疼痛控制，同时最大程度地减少神经系统和胃肠道的副作用，仍有待进一步的研究解决。

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