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Analgesia after neurosurgery

Afolabi Muyiwa Owojuyigbe, Edward O Komolafe, Anthony T Adenekan, Muyiwa A Dada, Chiazor U Onyia, Ibironke O Ogunbameru, Oluwafemi F Owagbemi, Ademola O Talabi, Fola A Faponle
BACKGROUND: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. OBJECTIVE: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital...
April 2016: African Journal of Paediatric Surgery: AJPS
W Lee Titsworth, Justine Abram, Peggy Guin, Mary A Herman, Jennifer West, Nicolle W Davis, Jennifer Bushwitz, Robert W Hurley, Christoph N Seubert
OBJECTIVE The inclusion of the pain management domain in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey now ties patients' perceptions of pain and analgesia to financial reimbursement for inpatient stays. Therefore, the authors wanted to determine if a quality improvement initiative centered on a standardized analgesia protocol could significantly reduce postoperative pain among neurosurgery patients. METHODS The authors implemented a 10-month, prospective, interrupted time-series trial of a quality improvement initiative...
March 11, 2016: Journal of Neurosurgery
Vinit K Srivastava, Sanjay Agrawal, Sanjay Kumar, Abhishek Mishra, Sunil Sharma, Raj Kumar
BACKGROUND: Effective management of analgesia and sedation in the intensive care unit depends on the needs of the patient, subjective and/or objective measurement and drug titration to achieve specific endpoints. AIM: The present study compared the efficacy of dexmedetomidine, propofol and midazolam for sedation in neurosurgical patients for postoperative mechanical ventilation. MATERIALS AND METHODS: Ninety patients aged 20-65 years, ASA physical status I to III, undergoing neurosurgery and requiring postoperative ventilation were included...
September 2014: Journal of Clinical and Diagnostic Research: JCDR
Li-Xin An, Xue Chen, Xiu-Jun Ren, Hai-Feng Wu
We performed this study to examine the effect of electro-acupuncture (EA) on postoperative pain, postoperative nausea and vomiting (PONV) and recovery in patients after a supratentorial tumor resection. Eighty-eight patients requiring a supratentorial tumor resection were anesthetized with sevoflurane and randomly allocated to a no treatment group (Group C) or an EA group (Group A). After anesthesia induction, the patients in Group A received EA at LI4 and SJ5, at BL63 and LR3 and at ST36 and GB40 on the same side as the craniotomy...
2014: American Journal of Chinese Medicine
William Lee Titsworth, Justine Abram, Peggy Guin, Jennifer Bushwitz, Robert Hurley, Christoph Seubert, William A Friedman
INTRODUCTION: It is well established that postoperative pain has far reaching effects on patient physiology and length of stay. However, recent CMS initiatives such as the HCAHP survey have forced hospitals and neurosurgery departments to improve postoperative pain control. METHODS: A prospective quality improvement trial with a time series design was performed among postoperative neurosurgical patients at a large tertiary academic center. The Multimodal Pain Initiative (MMPI) consisted of improved preoperative documentation of risk factors for postoperative pain, standardization of intraoperative analgesia, improved recognition of postoperative pain by floor nurses, and development of a standardized pain management protocol...
August 2014: Neurosurgery
Catarina Santos Carvalho, Filipa Resende, Maria João Centeno, Isabel Ribeiro, João Moreira
BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH) during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM). The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. CASE REPORT: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other deficits on admission to the emergency room...
March 2013: Brazilian Journal of Anesthesiology
Catarina Santos Carvalho, Filipa Resende, Maria João Centeno, Isabel Ribeiro, João Moreira
BACKGROUND AND OBJECTIVES: Subarachnoid hemorrhage (SAH) during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM). The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. CASE REPORT: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other deficits on admission to the emergency room...
March 2013: Brazilian Journal of Anesthesiology
Mathew R Guilfoyle, Adel Helmy, Derek Duane, Peter J A Hutchinson
BACKGROUND: Up to two-thirds of patients report moderate to severe surgical site pain after craniotomy procedures, and there is understandable reluctance to manage these symptoms with systemic opioids that may impair neurological assessment. Furthermore, there is a lack of consensus and evidence concerning alternative analgesia strategies for cranial neurosurgery. Regional scalp block (RSB) is an established technique that involves infiltration of local anesthetic (LA) at well-defined anatomical sites targeting the major sensory innervation of the scalp...
May 2013: Anesthesia and Analgesia
Sugantha Ganapathy, Jonathan Brookes, Robert Bourne
Pain after major abdominal, orthopedic, and thoracic surgeries can be significant causing unacceptable morbidity. Poorly controlled pain results in patient dissatisfaction and may also be associated with major morbidities, including perioperative myocardial ischemia, pulmonary complications, altered immune function, and postoperative cognitive dysfunction. Various techniques are currently used to manage this pain, and opioids are amongst the most frequently used. Recent literature supports the use of regional anesthesia in the form of various peripheral nerve blocks as a better alternative...
June 2011: Anesthesiology Clinics
J H Teo, G M Palmer, A J Davidson
There is little information about analgesia use or pain experienced in children after neurosurgery. The aims of this study were to assess the degree of pain experienced by children after neurosurgery and the analgesic regimens used, and to identify factors associated with significant pain. Data for 52 children who underwent craniotomy were collected contemporaneously over 72 hours. Data included demographics, intraoperative surgical and anaesthetic details, postoperative medications and postoperative pain scores as routinely collected by nursing staff Pain was also assessed by an independent observer (auditor) using an age and developmentally appropriate tool, on a scale from zero to 10...
January 2011: Anaesthesia and Intensive Care
D Kotak, B Cheserem, A Solth
Patients undergoing craniotomy may experience moderate to severe pain postoperatively. An audit of analgesia of post-craniotomy patients at King's College Hospital demonstrated variable analgesic prescribing practices and suboptimal analgesia in some patients. Prior to introducing a formal post-operative analgesic regime, a survey of the adult neurosurgical units within the United Kingdom was undertaken to ascertain whether there was a general consensus regarding post-craniotomy pain management. Questions were asked as to whether there was a standardized analgesic regime/protocol; which first, second, third, and fourth-line analgesics were used; whether non-steroidal anti-inflammatory drugs were used; what the preferred anti-emetic was; and whether pain was routinely assessed...
2009: British Journal of Neurosurgery
Hélène Batoz, Olivier Verdonck, Christelle Pellerin, Gaëlle Roux, Pierre Maurette
BACKGROUND: The issue of postoperative pain after neurosurgery is controversial. It has been reported as mild to moderate and its treatment may be inadequate. Infiltration of the surgical site with local anesthetics has provided transient benefit after craniotomy, but its effect on chronic pain has not been evaluated. Accordingly, we designed the present study to test the hypothesis that ropivacaine infiltration of the scalp reduces acute and persistent postoperative pain after intracranial tumor resection...
July 2009: Anesthesia and Analgesia
Ross M Moskowitz, Jennifer L Young, Geoffrey N Box, Laura S Paré, Ralph V Clayman
OBJECTIVE: Robotic technology has been used in a variety of surgical procedures for its 3D magnification and precision. Minimally invasive techniques have already become common in neurosurgery; however, robotic-assisted procedures in neurosurgery are still a relatively new frontier. This report describes the first use of robotic technology to resect a left thoracolumbar neurofibroma. CASE REPORT: A 19-year-old male with a family history of neurofibromatosis was diagnosed with a suspected 3-cm x 4-cm neurofibroma in the T12-L1 left paraspinal area...
January 2009: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Christian Ayoub, François Girard, Daniel Boudreault, Philippe Chouinard, Monique Ruel, Robert Moumdjian
We compared transitional analgesia provided by scalp nerve block (SNB) or morphine after remifentanil-based anesthesia in neurosurgery. Fifty craniotomy patients were randomly divided into two groups: morphine (morphine 0.1 mg x kg(-1) IV after dural closure and an SNB performed with 20 mL of 0.9% saline at the end of surgery) and block (10 mL of 0.9% saline instead of morphine after dural closure and an SNB performed with a 1:1 mixture of bupivacaine 0.5% and lidocaine 2% at the end of surgery). Postoperative pain was assessed at 1, 2, 4, 8, 12, 16, and 24 h using a 10-point numerical rating scale...
November 2006: Anesthesia and Analgesia
Andréa Ungaro Peón, Solange Diccini
In the postoperative period, 47% to 75% of the patients report some degree of pain. This study aimed to evaluate pain in the pre and postoperative period of patients submitted to craniotomy. This prospective research was carried out at the neurosurgery unit of a large Brazilian hospital. For a quantitative evaluation of pain, the verbal numeric 0-10 rating scale was used. Forty patients with a mean age of 36 years were evaluated. In the preoperative period, 34 (85%) patients indicated headache as the main cause of pain...
July 2005: Revista Latino-americana de Enfermagem
Andreas Karabinis, Kostas Mandragos, Spiros Stergiopoulos, Apostolos Komnos, Jens Soukup, Ben Speelberg, Andrew J T Kirkham
INTRODUCTION: This randomised, open-label, observational, multicentre, parallel group study assessed the safety and efficacy of analgesia-based sedation using remifentanil in the neuro-intensive care unit. METHODS: Patients aged 18-80 years admitted to the intensive care unit within the previous 24 hours, with acute brain injury or after neurosurgery, intubated, expected to require mechanical ventilation for 1-5 days and requiring daily downward titration of sedation for assessment of neurological function were studied...
August 2004: Critical Care: the Official Journal of the Critical Care Forum
E Verchère, B Grenier
Neurosurgery has for a long time been considered as a minimal painful surgery. This explains why there are few references in the literature concerning postoperative neurosurgical pain. Recent papers have demonstrated that even if postoperative pain is less important than in other specialities, such pain exists and should be taken care of. Rapid neurological recovery is now possible because of the progress in the surgical techniques and the introduction of new anaesthetic drugs. This implies a strict postoperative analgesic strategy in order to avoid both direct and indirect complications associated with pain...
April 2004: Annales Françaises D'anesthèsie et de Rèanimation
Fabienne Perren, Eric Buchser, Dominique Chédel, Lorenz Hirt, Philippe Maeder, François Vingerhoets
Long-term intrathecal drug administration using implanted pumps is increasingly used in the treatment of chronic refractory pain [Anderson and Burchiel 1999, Neurosurgery 44 (1999) 289; Krames 2002, Best Pract Res Clin Anaesthesiol 16 (2002) 619; Wallace 2002, Neurology 59 (2002) S18]. Extensive clinical experience over the last 15 years suggests that in selected cases the technique is safe, although infections, system malfunction and drug-related complications have been reported. In most cases, drug-related spinal cord injuries have resulted from the compression of a spinal inflammatory mass or abcess rather than from a direct neurotoxic effect...
May 2004: Pain
T Cafiero, R Burrelli, P Latina, P Mastronardi
AIM: Transition from the end of remifentanil infusion and postoperative analgesia must be planned carefully owing to remifentanil's (R) rapid offset. Intraoperative morphine has been used for the transition to postoperative analgesia following remifentanil-based anesthesia. Sufentanil (S) is a very potent opioid with high micro-receptor affinity, a much wider therapeutic index and a lower fractional receptor occupancy. These pharmacological and dynamics features make sufentanil an interesting alternative to morphine for immediate postoperative analgesia...
January 2004: Minerva Anestesiologica
P Revol, A Gleizal, T Kraft, P Breton, M Freidel, P Bouletreau
The authors report a case of cervico-facial cellulitis with brain abscess after mandibular third molar removal. This is the observation of a 26 years old boy surgically treated for a cervico-facial cellulitis ten days after a third molar's removal. He was given anti-inflammatory drugs after removal for analgesia. After a phase of clinical improving, the patient developed pulmonary and brain abscess with neurological signs. He needed neurosurgery in emergency. After eight weeks of antibiotic treatment, the patient was cured with aftereffects (jaw constriction and sensory disorders of the right thigh)...
October 2003: Revue de Stomatologie et de Chirurgie Maxillo-faciale
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