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Analgesia after neurosurgery

Jessica E Burjorjee, Rachel Rooney, Melanie Jaeger
OBJECTIVE: In this case report, we describe a case of epidural hematoma following epidural analgesia in a patient with recent cessation of a direct oral anticoagulant (DOAC). CASE REPORT: An 89-year-old woman requiring upper abdominal surgery presented with multiple comorbidities, including a prior cerebrovascular accident resulting in a left-sided hemiparesis and atrial fibrillation requiring anticoagulation with rivaroxaban. In accordance with our departmental guidelines at the time of procedure, rivaroxaban was discontinued 4 days preoperatively...
April 2018: Regional Anesthesia and Pain Medicine
T Akhigbe, A Zolnourian
BACKGROUND: The effective management of postoperative pain have the tendency to reduce morbidity and mortality. According to International Association for the Study of Pain (I.A.S.P), pain is an unpleasant sensory and emotional experience associated with existing or potential tissue injury. Post-operative pain is most severe during the first 72h following surgery and is usually of limited time frame mostly. METHODS: Literature search conducted using EMBASE (1980 onwards), MEDLINE (1946 onwards) and Cochrane Central register of Controlled Trials database for systematic reviews...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Sarah Pinkernell, Katrin Becker, Ute Lindauer
The most important acute neurological diseases seen at neurosurgery departments are traumatic brain injuries (TBI) and subarachnoid hemorrhages (SAH). In both diseases the pathophysiological sequela are complex and have not been fully understood up to now, and rodent models using rats and mice are most suitable for the investigation of the pathophysiological details. In both models, surgery is performed under anesthesia, followed by assessment of their functional outcome and behavioral testing before brain tissue analysis after euthanasia...
December 2016: Laboratory Animals
Shiyu Su, Chunguang Ren, Hongquan Zhang, Zhong Liu, Zongwang Zhang
Background: Approximately 60% of patients experience moderate-to-severe pain after neurosurgery, which primarily occurs in the first 24-72 h. Despite this, improved postoperative analgesia solutions after neurosurgery have not yet been devised. This retrospective study was conducted to evaluate the effect of intra- and post-operative infusions of dexmedetomidine (DEX) plus sufentanil on the quality of postoperative analgesia in patients undergoing neurosurgery. Methods: One hundred and sixty-three post-neurosurgery patients were divided into two groups: Group D (DEX infusion at 0...
2016: Frontiers in Pharmacology
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...
December 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
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