Postoperative pain management after craniotomy: Literature review and evaluation of evidence

Background: The effective management of postoperative pain have the tendency to reduce morbidity and mortality. Currently it is becoming clear that appropriate and adequate analgesia is a significant component of post craniotomy care. The goal of this review is to analyse and appraise evidence for postoperative analgesia following craniotomy. Methods: Literature search conducted using EMBASE, Medline and Cochrane database for systematic reviews. Key words applied were” postoperative analgesia”, “neurosurgery”, “neurosurgical procedures”. Resultant yield limited to 10 years, English language journal, intracranial (craniotomy) surgeries. Studies were limited to English and those involving humans. Studies limited from 1995 to 2015. Relevant studies were isolated for further critique. About 30 trials were identified but some could not be retrieved. Results: Total of 140 citations were identified, after thorough screening non relevant studies and non-randomised clinical trials were exempted. One systematic review and three randomised controlled study, Studies were limited to English and those involving humans. Conclusion: The data available showed improved analgesia with use of codeine sulphate against the backdrop of the popular tramadol which is a weak opioid fraught with significant post-operative nausea and vomiting. Also some evidences support use of regional scalp block for post craniotomy analgesia. The non-narcotics paracetamol and NSAIDs such Ketoprofen are useful analgesia compliments