Headache Management in Neurosurgical Postoperative Patients

Main Article Content

Claudia Cervera Martinez Fernando J. Zermeño-Pohls Erik Burgos- Sosa J. Ramon Martínez-Pablos Manuel Islas-Alvarez Juan Luis Gomez-Amador

Abstract

Introduction: Headache in neurosurgical patients is an important clinical problem that has been receiving an increasing amount of attention. However, only a few studies have described cases of headache following craniotomy, and even fewer have proposed pain management for this pathology. In contrast, general postoperative pain has been extensively studied, and there are thus many guidelines to treat such pain. Here we propose a regimen that includes the use of analgesics based on postoperative pain guidelines.


Material and Methods: A randomized prospective study was performed on all neurosurgical patients who had underwent craniotomy at the National Institute of Neurology and Neurosurgery between September 2016 and September 2017. The subjects were subdivided into control and experimental groups. Each group comprised 50 patients. Analgesic management in the experimental group was based on multimodal analgesia.


Results and Discussion: There was a significant difference in the Analogue Visual Scale scores between the control and experimental groups, both on the last hospitalization day (p = 0.000) and at the 6-month follow-up (p = 0.002). There was thus a significant amelioration of pain among patients in the experimental group when compared to those in the control group.


Adequate preoperative and follow up pain management is of most importance for patient care and outcome.Our findings indicate that there was a decrease in pain following multimodal analgesia in post-craniotomy patients


Conclusion: Based on the results obtained in this study and the previously reported evidence, we suggest that postoperative management of acute and persistent headache in patients who undergo craniotomy should comprise multimodal analgesia.

Keywords: postoperative pain management, headache, craniotomy, opioids, persistent pain, acute pain, multimodal analgesia

Article Details

How to Cite
MARTINEZ, Claudia Cervera et al. Headache Management in Neurosurgical Postoperative Patients. Medical Research Archives, [S.l.], v. 12, n. 4, apr. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/4653>. Date accessed: 27 may 2024. doi: https://doi.org/10.18103/mra.v12i4.4653.
Section
Research Articles

References

1. Subbarao B.S, Blessen CE. Headache post craniotomy. Stat Pearls Publishing.2022 ;1(1): 412-434
2. Gray L.C, Matta B.F. Acute and chronic pain following craniotomy: a review. Anaesthesia .2005; 60 (1): 693-704.
3. Lutman B, Bloom J, Nussenblatt B, Romo V. A .Contemporary perspective on the management of post-craniotomy headache and pain. Curr Pain Headache Rep . 2018 ;22(10):69.
4. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia .2018 ;38(1):1-211.
5. Jandial R, McCormick P, Black P. Core techniques in intraoperative neurosurgery. Elsevier/Sounders. 2011;1(1): 234-256.
6. Neria F, Ortega JL, Martinez J, Galvez R, De la Torre R, Torres LM. Evaluación mediante AEREE de guías de práctica clínica en dolor postoperatorio. Rev Esp Anestesiol Reanim . 2005 ; 52 (1):349-54.
7. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, Bickler S, Brennan T, et al. Management of postoperative pain: a clinical practice guideline ; American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia Executive Committee. Journal of Pain .2016; 17(1) :131-57.
8. Haley J. E, Dickenson A.H. ,Evidence for spinal N-Methyl-D-Aspartate receptor involvement in prolonged chemical nociception in the rat. Brain Res .2016 ; 1545 (1) :58-60
9. Bourlinet E, Altier C, Hilderbrande ME, Trang T, Salter MW, Zamponi GW. Calcium permeable ion channels in pain signaling. Physiol Rev. 2014; 94(1) :81-140.
10. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain .2011; 152(2):2-15.
11. Vadivelu N, Mistra S, Narayan D. Recent advances in postoperative pain medicine. Yale J Biol Med . 2010; 83(1) :11-25.
12. Toquero F, Zarco J. Guía de practica clínica del dolor y su tratamiento. IMC . 2004 ; 1 (1): 25-34.
13. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects, Pain Physician .2008 ; 11(1) :105-20.
14. Fernandez C.F, Gomez M.P. Dolor agudo y postoperatorio. ACED. 2011 ;1(2): 45-78.
15. Warfield C, Kahn C. H, Acute pain management. Programs in US hospitals and experiences and attitudes among US adults. Anesthesiology .1994; 83(1) :1090-4.
16. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology .2012; 116(3) :248-73.
17. NHS Quality Improvement Scotland, Best practice statement: postoperative pain management. 2004; 1(2): 532-6.
18. Kong VKF, Irwin MG. Gabapentin a multimodal perioperative drug. Br J Anesth .2007; 99(6) :775-86.
19. Peng PWH, Wijeysundera DN, Li CF. Use of gabapentin for perioperative pain control a meta-analysis. Pain Res Manage .2007; 12(1) :85-92.
20. Chronic Pain Medical Treatment Guidelines and Opioids Treatment Guidelines, Medical Treatment Utilization Schedule (MTUS). 2009 ;1(1):235-7.
21. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg . 2003; 97(12):534-40.
22. Guevara-Lopez U, Covarrubias–Gomez A, Delille-Fuentes R, Hernandez- Ortiz A, Carrillo-Esper R, Moyayo-Garcia D. Parámetros de práctica para el manejo del dolor agudo perioperatorio. Cir Ciruj .2005; 73(2) :223-32.
23. C Small, H Laycock, Acute postoperative pain management, British Journal of Surgery. 2020 ; 107( 2):70-80.
24. Michael A. E. Ramsay Acute Postoperative Pain Management, Baylor University Medical Center Proceedings. 2000; 13(3) : 244-247.
25. Mitra, S., Carlyle, D., Kodumudi, G. et al. New Advances in Acute Postoperative Pain Management. Curr Pain Headache Rep .2022; 35 (2) :1-14
26. Flexman, Alana M; Ng, Julie L; Gelb, Adrian W, Acute and chronic pain following craniotomy, Current Opinion in Anaesthesiology .2010; 23(5):551-557.
27. N. Quiney, R. Cooper, M. Stoneham & F. Walters . Pain after craniotomy. A time for reappraisal, British Journal of Neurosurgery.1999; 10(3): 295-300
28. Lee EJ, Lee MY, Shyr MH, Cheng JT, Toung TJ, Mirski MA, et al. Adjuvant bupivacaine scalp block facilitates stabilization of hemodynamics in patients undergoing craniotomy with general anesthesia: a preliminary report. J Clin Anesth .2006 ;18(4):490–4.
29. Mosek AC, Dodick DW, Ebersold MJ, Swanson JW. Headache after resection of acoustic neuroma. Headache . 1999; 39(2):89–94.
30. Talke PO, Gelb AW. Postcraniotomy pain remains a real headache. Eur J Anaesthesiol .2005 ; 22(2) :325–7.
31. Rocha-Filho PA. Post-craniotomy headache: a clinical view with a focus on the persistent form. Headache ;55(5):733-8
32. Dunbar PJ, Visco E, Lam AM. Craniotomy procedures are associated with less analgesic requirements than other surgical procedures. Anesth Analg .1999; 88(1):335–40.
33. Saramma PP, Mathew R. Assessment of post-operative pain and its management among patients undergoing craniotomy. Nurs J India . 2013 ; 104(3):101–3.
34. Atalano PJ, Jacobowitz O, Post KD. Prevention of headache after retrosigmoid removal of acoustic tumors. Am J Otol .1996; 17(1) :904–8.
35. Lai LT, Ortiz-Cardona JR, Bendo AA. Perioperative pain management in the neurosurgical patient. Anesthesiol Clin. 2012; 30(2) :347–67