Difficulty in Evaluating Pharmacologic Interventions Following Craniotomy

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Studies reporting pharmacological and adjuvant analgesic modalities for post-craniotomy pain control have significant divergence in their research methods.
Studies reporting pharmacological and adjuvant analgesic modalities for post-craniotomy pain control have significant divergence in their research methods.

HealthDay News -- Studies reporting pharmacological and adjuvant analgesic modalities for post-craniotomy pain control have significant divergence in their research methods, according to a review published online on December 20 in Pain Practice.1

Georgia G. Tsaousi, MD, PhD, from Aristotle University of Thessaloniki in Greece, and colleagues conducted a systematic review of the literature to report current clinical evidence relating to pharmacological and adjuvant analgesic modalities for post-craniotomy pain control. Nineteen randomized controlled trials (RCTs) with 1,805 patients were included.

The researchers found that quality of research methods was moderate to good for most of the studies. Fourteen RCTs assessed systemic pharmacological intervention. Superior pain relief was provided by opioids (5 RCTs), with no significant side effects, but the study quality was low. Adequate craniotomy pain control was presented by diclofenac (3 RCTs), without adverse effects, but there was no support for parecoxib. Adequate transitional analgesia was provided by dexmedetomidine (3 RCTs), but further research is needed. Very limited data were available on the analgesic efficacy of gabapentin, pregabalin, and intravenous lidocaine (1 RCT each). In the early postoperative period, scalp infiltration/block provided adequate analgesia (3 RCTs), while more studies are needed to verify the analgesic benefit from non-pharmacological interventions (2 RCTs).

"No definite recommendations can be made based on this systematic review of pharmacological interventions following craniotomy due to significant divergence in the methodology of available studies," the authors write.

 

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Reference

  1. Tsaousi GG, Logan SW, Bilotta F. Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature. Pain Pract. 2016. doi: 10.1111/papr.12548.
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