Postoperative analgesia

Ensure effective pain control after neurosurgical procedures
Minimize opioid use and associated side effects
Avoid analgesia-related complications (e.g., bleeding, oversedation)
Facilitate early mobilization and recovery

Adults undergoing craniotomy or intracranial procedures
Tailored for patients without active bleeding, severe coagulopathy, or NSAID contraindications

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

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

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

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

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

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.