Postoperative pain management in the neurosurgical patient

International Anesthesiology Clinics
M J Cousins, H S Umedaly

Abstract

We hope to have inspired an interest in approaching the pain management issues in this challenging group of patients. Despite significant progress in understanding the pathophysiology of pain, the development of therapeutic options, and the publication and dissemination of guidelines, this progress does not seem to have been adopted into clinical practice. Bonica has stated "for many years I have studied the reasons for inadequate management of postoperative pain, and they remain the same.... Inadequate or improper application of available information and therapies is certainly the most important reason". Let us accept the challenge to re-evaluate pain management in the postoperative neurosurgical patient. Future development may provide enhanced multimodal analgesia with the development of enantioselective NSAIDs and peripherally acting opioids that do not cross the blood-brain barrier. Targeted inhibition of the central neuroplasticity that underlies sensitization, rather than attempts to use pre-emptive analgesics, may be more fruitful. Inhibition of excitatory amino acids may prove beneficial for perioperative neuroprotection and pain management. In addition, longer-acting local anesthetics show significant promise. The impo...Continue Reading

Citations

Jun 1, 2005·Annales Françaises D'anesthèsie Et De Rèanimation·L BeydonA Bonafé
Jul 13, 2002·Journal of the American College of Surgeons·William P SchecterJan K Horn
May 20, 2014·Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses·Christine Echegaray-BenitesCéline Gélinas
Dec 4, 2004·Nursing in Critical Care·Gemma Roberts
Sep 24, 2020·British Journal of Neurosurgery·Carlos Michell Tôrres SantosNicollas Nunes Rabelo
Apr 19, 2006·Anaesthesia and Intensive Care·I BalaV K Khosla
Oct 30, 2001·Anesthesia and Analgesia·A NguyenD C Girard

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