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Multimodal analgesia for craniotomy

机译：Craniotomy的多峰镇痛

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Purpose of review To explore the data for and against the use of the various components of multimodal analgesia in cranial neurosurgery. Recent findings Postcraniotomy pain is a challenging clinical problem in that analgesia must be accomplished without affecting neurologic function (i.e. 'losing the neurologic exam'). The traditional approach with low-dose opioids is often insufficient and can cause well recognized side effects. Newer multimodal analgesic approaches have proven beneficial in a variety of other surgical patient populations. The combined use of multiple nonopioid analgesics offers the promise of improved pain control and reduced opioid administration, while preserving the clinical neurologic exam. Specifically, acetaminophen and gabapentinoids should be considered for craniotomy patients, both preoperatively and postoperatively. The gabapentinoids have the added benefit of reduced nausea. Scalp blocks have moderate quality evidence supporting their use over incisional infiltration alone, with analgesia that extends into the postoperative period. Intraoperative dexmedetomidine reduces postoperative opioid requirements with the added benefit of reduced postcraniotomy hypertension. Methocarbamol, NSAIDs [both nonspecific cyclooxygenase (COX) 1 and 2 inhibitors and specific COX-2 inhibitors], ketamine, and intravenous lidocaine require further data regarding safety and efficacy in craniotomy patients. Opioids are the mainstay for treating acute postcraniotomy pain but should be minimized. The evidence to support a multimodal approach is growing; neuroanesthesiologists and neurosurgeons should seek to incorporate multimodal analgesia into the perioperative care of craniotomy patients. Preoperative and postoperative gabapentin and acetaminophen, intraoperative dexmedetomidine, and scalp blocks over incisional infiltration have the most data for benefit, with good safety profiles. Further research is needed to define the safety, efficacy, and dosing parameters for NSAIDs including COX-2 inhibitors, methocarbamol, ketamine, and intravenous lidocaine in cranial neurosurgery.
机译：审查目的以探索颅神经外科多峰镇痛各种组分的数据。最近的发现后肺炎疼痛是必须在不影响神经功能的情况下实现镇痛的挑战性临床问题（即“失去神经系统考试”）。具有低剂量阿片类药物的传统方法通常不足，可能导致良好的认可副作用。较新的多模式镇痛方法在各种其他外科患者群体中被证明是有益的。多种非磷酸镇痛药的结合使用提供了改善疼痛控制和降低的阿片类药物管理，同时保留临床神经学检查。具体而言，术前和术后，应考虑乙酰氨基酚和甘蓝丁醇糖。加巴蛋白素具有减少恶心的额外益处。头皮块具有适度的质量证据，其支持单独使用切口渗透，镇痛延伸到术后期。术中的右甲酰过甲酰胺术后术后术后术后术治疗术后术治疗。甲基氨基甲酰胺，NSAID [非特异性环氧化酶（COX）1和2抑制剂和特定的COX-2抑制剂]，氯胺酮和静脉利多卡因需要进一步的关于Craniotomy患者的安全性和功效的数据。阿片类药物是治疗急性后期术疼痛的主体，但应最小化。支持多式联运方法的证据正在增长;神经抑制剂和神经外科医生应寻求将多模式镇痛纳入Craniotomy患者的围手术期护理。术前和术后加巴普顿和乙酰氨基酚，术中的右传嘌呤，和直接渗透的头皮段具有最多的有益数据，具有良好的安全性曲线。需要进一步研究，以确定NSAID的安全性，疗效和给药参数，包括COX-2抑制剂，甲壳氨基醇，氯胺酮和静脉注射LIDOCAIN在颅神经外科。

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