Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-13T11:28:58.533Z Has data issue: false hasContentIssue false
  • English
  • Français

Post-craniotomy analgesia: current practices in British neurosurgical centres – a survey of post-craniotomy analgesic practices

Published online by Cambridge University Press:  11 May 2005

G. C. Roberts
G. C. Roberts
Affiliation:
University Hospital of Wales, B4 Neurosurgery, Cardiff, Wales, UK
Get access

Extract

Summary

Background and objective: An evaluation of post-craniotomy analgesia within the University Hospital of Wales Neurosurgical Unit, Cardiff, found that many patients were experiencing moderate to severe pain post-craniotomy. It was therefore decided to undertake a nationwide survey of analgesic practices in order to establish best practice guidelines and benchmark with other units.

Method: A postal questionnaire was sent to the senior nurse of every Neurosurgical Directorate within the UK inquiring about the current, standard analgesic practices for post-craniotomy patients in their unit.

Results: Completed replies were received from 23 of the 33 centres (70%). Intramuscular (i.m.) codeine phosphate was found to be the principal first-line analgesic used post-craniotomy. Only three centres used morphine as the first-line analgesic and only one centre used patient controlled analgesia routinely. The majority of centres (82%) used balanced analgesia. Pain assessments were only carried out in 57% of centres and no centre used a validated pain assessment tool specifically for dysphasic patients.

Conclusions: Codeine phosphate continues to be the mainstay of post-craniotomy analgesia, however, it is proposed that patient controlled analgesia with morphine is an efficacious and safe alternative.

Keywords

PAIN, postoperative, craniotomyANALGESIA, patient-controlled, intramuscularANALGESICS, codeine, morphine
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 5 , May 2005 , pp. 328 - 332
Copyright
© 2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aitkenhead A, Smith G, eds. Neurosurgical Anaesthesia, 3rd edn. New York, USA: Churchill Livingstone Inc, 1998.
Craft T, Upton P. Key Topics in Anaesthetia, 2nd edn. Oxford, England: BIOS Scientific Publishers Ltd, 1997.
Drummond J, Patel P. Neurosurgical Anaesthesia. In: Miller R, ed. Anaesthesia, 5th edn, Vol. 2. New York, USA: Churchill Livingstone Inc, 2000.
Atkinson R, Rushman G, Davies N. Lees Synopsis of Anaesthesia, 11th edn. Oxford, England: Butterworth Heinnemann Ltd, 1993.
Feldman S. Neurological conditions and anaesthesia. In: Churchill Davidson H, ed. A Practice of Anaesthesia, 5th edn. London, England: Lloyd Luke (Medical Books) Ltd, 1984.
Turner J. Anaesthesia for neurosurgery. In: Healey T, Cohen P, eds. A Practice of Anaesthesia, 6th edn. London, England: Edward Arnold, 1995.
Geevarghese K. Post operative care of the patient undergoing neurological surgery. Int Anaesthesiol Clin 1977; 15: 309–320.Google Scholar
Stoneham M, Cooper R, Quiney N, Walters F. Pain following a craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate. Anaesthesia 1996; 51: 1176–1178.Google Scholar
Stoneham M, Walters F. Post operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists. Eur J Anaesthesiol 1995; 12: 571–575.Google Scholar
Goldsack C, Souplak S, Smith M. A double blind comparison of codeine and morphine for post operative analgesia following intracranial surgery. Anaesthesia 1996; 51: 1029–1032.Google Scholar
Graham A, Reid M, Andrews P. Perception of pain experienced and adequacy of analgesia following elective craniotomy. Anaesthesia 1999; 54: 814–815.Google Scholar
De Benedittis G, Lorenzetti A, Miglione M, et al. Post-operative pain in neurosurgery: a pilot study in brain surgery. Neurosurgery 1996 38: 466–470.Google Scholar
Directory of Critical Care. Directory of Critical Care UK. London, England: CMA Medical Data, 2003.
Cousins M, Umedaly H. Post-operative pain management in the neurosurgical patient. Int Anaesthesiol Clin 1996; 34: 179–193.Google Scholar
Way W, Fields H, Schumacher M. Opioid analgesics and antagonists. In: Katzung B, ed. Basic and Clinical Pharmacology, 8th edn. New York, USA: Langer Medical Books, 2001.
Dollery C. Therapeutic Drugs, Vol. 1. Edinburgh, Scotland: Churchill Livingstone Inc, 1991.
Chen ZR, Somogyi AA, Reynolds G, Bochner F. Disposition and metabolism of codeine after single and chronic doses in one poor and seven extensive metabolisers. Br J Clin Pharmacol 1991; 31: 381–390.Google Scholar
Desmules J, Gascon M, Dayer P, et al. Impact of environmental and genetic factors on codeine analgesia. Eur J Clin Pharmacol 1991; 41: 23–26.Google Scholar
Yue Q, Hasselstrom J, Svensson J, et al. Pharmokinetics of codeine and its metabolites in Caucasian healthy volunteers. Br J Clin Pharmacol 1991; 31: 635–642.Google Scholar
Quilding H, Lundqvist G, Boreus L, et al. Analgesic effect and concentration of codeine and morphine after 2 dose levels of codeine following oral surgery. Eur J Clin Pharmacol 1993; 44: 319–323.Google Scholar
Sindrup S, Brosen K, Bjerring P, et al. Codeine increases pain thresholds to copper vapour laser treatment stimuli in EMs but not PMs of sparteine. Clin Pharmacol 1993; 49: 686–694.Google Scholar
Williams D, Patel A, Howard R. Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. Br J Anaesth 2002; 89: 839–884.Google Scholar
Chen Z, Somogyi A, Bochner F. Polymorphic demethylation of codeine. Lancet 1988; 2: 914–915.Google Scholar
Eckhardt K, Shuxia L, Ammon S, et al. Same incidence of adverse events after codeine administration irrespective of the genetically determined differences in morphine formation. Pain 1998; 76: 27–33.Google Scholar
Poulsen L, Brasen K, Arendt-Nielsen L, et al. Codeine and morphine in extensive and poor metabolizers of sparteine. Eur J Clin Pharmacol 1996; 51: 289–295.Google Scholar
Leith B. Pharmacological management of pain after intracranial surgery. J Neurosci Nurs 1998; 30: 220–224.Google Scholar
Rivet M. The use of IV codeine in the neurosurgical patient population. J Can Assoc Crit Care Nurs 1995; 6: 12–15.Google Scholar
Austin K, Stapleton J, Mather L. Multiple IM injections. Pain 1980; 8: 47–62.Google Scholar
Semel J. Fever associated with repeated IM injections of analgesics. Rev Infect Disease 1986; 8: 68–72.Google Scholar
Quiney N, Cooper R, Stoneham M, et al. Pain after craniotomy – a time for reappraisal? Br J Neurosurg 1996; 10: 295–299.Google Scholar
Ng K, Tsui J, Yang S, et al. Increased nausea and dizziness when using tramadol for postoperative PCA compared with morphine. Eur J Anaesthesiol 1998: 15: 565–570.Google Scholar
Pang W, Mok M, Lin C, et al. Comparison of PCA with tramadol or morphine Can J Anaesth 1999; 46: 1030–1035.Google Scholar
Jeffrey H, Charlton P, Mellor D, et al. Analgesia after intracranial surgery: a double blind prospective comparison of codeine and tramadol. Br J Anaesth 1999; 83: 245–249.Google Scholar
Stubhaug A, Grimstad J, Breivik H. Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery. Pain 1995; 62: 111–118.Google Scholar
Stamer U, Maier C, Grondt B, et al. Tramadol in the management of post operative pain: a double blind, placebo and active drug controlled study. Eur J Anaesthesiol 1997; 14: 646–654.Google Scholar
Herbert C. Use of morphine for pain after intracranial surgery. Professional Nurse 2001; 16: 1029–1033.Google Scholar
Kathirvel S, Dash H, Bhatia A, et al. Effect of prophylactic ondansetron on post-operative nausea and vomiting after elective craniotomy. J Neurosurg Anaesth 2001; 13: 207–212.Google Scholar
Gardner J, Blough D, Drinkard C, et al. Tramadol and seizures. Pharmacotherapy 2001; 20: 1423–1431.Google Scholar
Jick H. The risks of seizure associated with tramadol. Pharmacotherapy 1998; 18: 607–611.Google Scholar
Cold GE, Felding M. Even small doses of morphine might provoke ‘luxury perfusion’ in the postoperative period after craniotomy. Neurosurgery 1993; 32: 327.Google Scholar
Vickers M, Szekely S, Read M, et al. Tramadol: pain relief by an opioid without fear of depression of respiration. Anaesthesia 1992; 47: 291–296.Google Scholar
Pasero C, McCaffery M. Avoiding opioid-induced respiratory depression. Am J Nurs 1994; 94: 25–30.Google Scholar
Carroll D. Pain assessment. In: Carroll D, Bowsher D, eds. Pain Management and Nursing Care. Oxford, UK: Butterworth Heinneman Ltd, 1993.
Voepel-Lewis T, Merkel S, Tait AR, et al. The reliability and validity of the face, legs, activity, cry, consolability observational tool as a measure of pain in children with cognitive impairment. Anesth Analg 2002; 95: 1224–1229.Google Scholar
Terstegen C, Koot HM, de Boer JB, et al. Measuring pain in cognitive impairment: pain response to surgical procedures. Pain 2003; 103: 187–198.Google Scholar