Postoperative analgesia [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Postoperative analgesia ======

===== 🎯 Objectives =====
  * Ensure effective pain control after [[neurosurgical procedure]]s
  * Minimize [[opioid]] use and associated side effects
  * Avoid [[analgesia]]-related complications (e.g., bleeding, oversedation)
  * Facilitate early [[mobilization]] and recovery

===== 🧠 Target Population =====
  * Adults undergoing craniotomy or intracranial procedures
  * Tailored for patients without active bleeding, severe coagulopathy, or NSAID contraindications

===== 🧰 Multimodal Analgesia Strategy =====
Combines pharmacologic and non-pharmacologic methods.

==== Day 0–3 (Immediate postoperative period) ====

^ Drug Class ^ Medication ^ Route ^ Frequency ^ Notes ^
| Acetaminophen | 1g | IV or PO | q6h | Baseline analgesia |
| NSAIDs | Ibuprofen 400–600 mg OR Ketorolac 15–30 mg | IV or PO | q8h | If no bleeding risk |
| Opioids (as needed) | Morphine 2–4 mg or Oxycodone 5 mg | IV or PO | PRN | Use lowest effective dose |
| Corticosteroids | Dexamethasone 4–8 mg | IV | q8h | Especially if cerebral edema |
| Local anesthetics | Scalp block (ropivacaine) | Intraop | Once | Optional, enhances early control |
| Anticonvulsants (if needed) | Gabapentin 100–300 mg | PO | q8–12h | For neuropathic component |

==== Day 4–7 (Early recovery) ====

* Taper opioids
* Continue acetaminophen + NSAID if tolerated
* Reassess dexamethasone; taper as indicated
* Consider introducing neuropathic adjuncts if persistent pain

===== 🚫 Contraindications =====
  * NSAIDs: active GI bleeding, severe renal insufficiency, platelet dysfunction, recent reoperation
  * Opioids: respiratory depression, severe sedation
  * Corticosteroids: poorly controlled diabetes, active infection

===== ⚠️ Monitoring and Side Effects =====
  * Daily pain scores (VAS/NRS)
  * Sedation and respiratory status (especially with opioids)
  * GI symptoms, renal function (NSAIDs)
  * Blood glucose (corticosteroids)
  * Neurological status: watch for changes that may mimic sedation

===== ✅ Discharge Recommendations =====
  * Oral acetaminophen +/- NSAID for 5–10 days
  * Opioids only if strictly necessary, limited quantity
  * Educate patient on red flags (headache with vomiting, drowsiness, vision changes)
  * Arrange follow-up for pain reassessment

===== 📌 Notes =====
  * Protocol may be adapted for spinal surgery, pediatric patients, or ICU settings.
  * All medications should be prescribed based on renal/hepatic function and individual risk factors.