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Pain Management in Post-Craniotomy Patients: A Survey of Canadian Neurosurgeons

Published online by Cambridge University Press:  02 December 2014

Basil Hassouneh ,
John E. Centofanti  and
Kesava Reddy
Basil Hassouneh*
Affiliation:
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
John E. Centofanti
Affiliation:
Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
Kesava Reddy
Affiliation:
Department of Surgery - Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada
*
Health Research Methodology Program, McMaster University, HSC-2C1 - 1200 Main St. W., Hamilton, Ontario, L8N 3Z5, Canada
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Abstract

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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 firstline 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.

Résumé:

Résumé:Contexte:

Même si la nécessité d’administrer des analgésiques chez les patients qui ont subi une craniotomie est maintenant mieux établie, c’est un sujet qui a été peu étudié. La classe et le régime posologique d’analgésiques qui convient le mieux à ces patients demeurent controversés. ‘objectif de cette étude était d’examiner les convictions et les pratiques actuelles des neurochirurgiens canadiens concernant le soulagement de la douleur après une craniotomie.

Méthode:

Une enquête a été faite auprès de tous les neurochirurgiens canadiens actuellement en pratique pour examiner les aspects suivants concernant l’analgésie chez les patients qui ont subi une craniotomie : le type d’analgésiques utilisés, les effets secondaires fréquemment observés, le degré de satisfaction concernant les régimes posologiques actuels et la justification de leurs habitudes de prescription.

Résultats:

Des 156 répondants potentiels, 103 neurochirurgiens (66%) ont complété l’enquête. L’analgésique de première ligne le plus fréquemment prescrit était la codéine (59%), suivi de la morphine (38%). L’utilisation d’un opioïde de deuxième ligne était significativement plus élevée parmi les prescripteurs de codéine que parmi les prescripteurs de morphine, soit 53% par rapport à 28% (p < 0,001). Les effets secondaires les plus courants étaient les nausées, la constipation et la dépression neurologique, rapportés par 76%, 66% et 27% des répondants respectivement. De plus, 90% d’entre eux ont rapporté un haut degré de satisfaction concernant leur choix actuel d’analgésique. Cependant, ils ont décrit leur choix comme étant motivé par une préférence personnelle ou un protocole plutôt que fondé sur des preuves.

Conclusions:

La codéine, un opioïde faible, est l’analgésique de première ligne le plus fréquemment prescrit chez les patients qui ont subi une craniotomie. Cette pratique est associée à un recours à des opioïdes puissants comme analgésique de rattrapage. Il faudra effectuer des essais cliniques pour évaluer si de nouveaux régimes de traitement pourraient optimiser le contrôle de la douleur tout en minimisant les effets secondaires neurologiques et gastro-intestinaux.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 3 , May 2011 , pp. 456 - 460
Copyright
Copyright © The Canadian Journal of Neurological 2011

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