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A survey of post-craniotomy analgesia in British neurosurgical centres: time for perceptions and prescribing to change?
British Journal of Neurosurgery, 10/01/09

Kotak D et al. – 31 adult neurosurgical units were surveyed. Twenty three percent (7 units) had a standardized analgesic regime/protocol and 65% routinely assessed pain post–operatively (20 units). Seventy percent of units used codeine phosphate or dihydrocodeine (22 units) as the first line opioid the other 30% using morphine (9 units). Forty two percent (13 units) used tramadol; patient controlled analgesia was used in 3 units. Regular paracetamol was prescribed in all but five (16%) units. Fifty two percent of units (16) used NSAIDs; of those that used NSAIDs 19% (3/16) prescribed them regularly. One unit used clonidine infusions. Anti–emetics were prescribed as required in all but two units. Cyclizine was the first–line anti–emetic in 45% of the units, ondansetron in 29% and metoclopramide in 16%. There is currently no consensus on pain management after craniotomy in neurosurgical centres in the UK. Until there are sufficiently powered randomized controlled studies to address the main safety and efficacy issues progress in this area will remain slow.

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