Abstract
Postoperative pain management in neurosurgical patients is a complex issue. Patients undergoing craniotomies have traditionally received opiates for the management of their postoperative pain. This limited approach to craniotomy pain issues yields results that are limited by the specificity of the opiate class. Additionally, opiate receptors lack specificity within the central nervous system. This results in the undesirable side effect of CNS depression which limits the dosing a patient can receive. Our elaborate pain pathway is a system that has been thoroughly studied and described in the literature. The Gate Control Theory, introduced by Melzak and Wall, was the first widely accepted pain theory. Our current understanding of the pain pathway also acknowledges a central modulation of pain primarily from the thalamus and the periaquductal gray. As our understanding of the complexity of the pain pathway has evolved, new medications such as cyclooxygenase-2 inhibitors and Tramadol have been utilized to more specifically modulate the pain pathway.
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References
Bekker A, Cooper P, Frempong-Boadu A, Babu R, Errico T, Lebovits A (2002) Evaluation of preoperative administration of the cyclooxygenase-2 inhibitor rofecoxib for the treatment of postoperative pain after lumbar disc surgery. Neurosurgery 50(5):1053–1058
Bourne HM, Rosenthal NR, Xiang J, Jordan D, Kamin M (2005) Tramadol/acetaminophen tablets in the treatment of postsurgical orthopedic pain. Am J Orthop 35:592–597
Brunton L (2006) Chapter 21: opioids. Goodman and Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York, NY.
Burchiel K, De Benedittis G (2002) Chapter 19: management of postoperative pain in neurosurgery. Surgical management of pain. Thieme, New York, NY.
Ferreira SH, Moncada S, Vane JR (1973) Prostaglandins and the mechanism of analgesia produced by aspirin-like drugs. Br J Pharmacol 49:86–97
Gimbel JS, Brugger A, Zhao W, Verburg KM, Geis GS (2001) Efficacy and tolerability of celecoxib versus hydrocodone/acetaminophen in the treatment of pain after ambulatory orthopedic surgery in adults. Clin Ther 23(2):228–241
Hawkey CJ (1999) Cox-2 inhibitors. Lancet 353:307–314
Hubbard RC, Naumann TM, Traylor L, Dhadda S (2003) Parecoxib sodium has opioid-sparing effects in patients undergoing total knee arthroplasty under spinal anaesthesia. Br J Anaesth 90(2):166–172
Leese PT, Hubbard RC, Karim A, Isakson PC, Yu SS, Geis GS (2000) Effects of celecoxib, a novel cyclooxygenase-2 inhibitor, on platelet function in healthy adults: a randomized, controlled trial. J Clin Pharmacol 40:124–132
Leese PT, Recker DP, Kent JD (2003) The COX-2 selective inhibitor, valdecoxib, does not impair platelet function in the elderly: results of a randomized controlled trial. J Clin Pharmacol 43:504–513
Leppert W, Luczak J (2005) The role of tramadol in cancer pain treatment-a review. Support Care Cancer 13:5–17
Melzack R, Wall PD (1965) Pain mechanism: a new theory. Science 150:971
Moncada S, Gryglewski R, Bunting S, Vane JR (1976) An enzyme isolated from arteries transforms prostaglandin endoperoxides to an unstable substance that inhibits platelet aggregation. Nature 263:663–665
Mordhorst C, Latz B, Kerz T, Wisser G, Schmidt A, Schneider A, Jahn-Eimermacher A, Werner C, Engelhard K (2010) Prospective assessment of postoperative pain after craniotomy. J Neurosurg Anesthesiol 22:202–206
Mukherjee D, Nissen SE, Topol EJ (2001) Risk of cardiovascular events associated with selective cox-2 inhibitors. JAMA 286:954–959
Mycek MJ, Harvey RA, Champe PC (2000) Nonsteroidal anti-inflammatory drugs. Pharmacology, 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA.
Palmer JD, Sparrow OC, Iannotti F (1994) Postoperative hematoma: a 5-year survey and identification of avoidable risk. Neurosurgery 35:1061–1065
Quiney N, Cooper R, Stoneham M, Walters F (1996) Pain after craniotomy. A time for reappraisal? Br J Neurosurg 10:295–299
Rahimi SY, Alleyne CH, Vernier E, Witcher MR, Vender JR (2010) Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis. J Neurosurg 112:268–272
Rahimi SY, Vender JR, Macomson SD, French A, Smith JR, Alleyne CH (2006) Post-operative pain management following craniotomy: evaluation and cost analysis. Neurosurgery 59:852–857
Seibert K, Masferrer JL (1994) Role of inducible cyclooxygenase (Cox-2) in inflammation. Receptor 4:17–23
Tang J, Li S, White PF, Wender RH, Quon R, Sloninski A (2002) Effect of parecoxib, a novel intravenous cyclooxygenase type-2 inhibitor on the postoperative opioid requirement and quality of pain control. Anesthesiology 96:1305–1309
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Special Thanks to Michael Jensen for Illustrations.
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Hughes, D., Rahimi, S.Y. (2011). Pain Management Following Craniotomy. In: Hayat, M. (eds) Tumors of the Central Nervous system, Volume 3. Tumors of the Central Nervous System, vol 3. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1399-4_35
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DOI: https://doi.org/10.1007/978-94-007-1399-4_35
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