Nonopioid Postoperative Pain Management in Neurosurgery.

Nathan A Shlobin, Joshua M Rosenow

Journal: Neurosurgery clinics of North America 2022;33(3):261-273

PMID: 35718395

Full Text on Elsevier Science View on PubMed

Abstract

Neurosurgeons have sought to minimize the use of opioids in neurosurgery. Preoperative medical strategies include methadone and gabapentinoids. Intraoperative strategies include local anesthetic infiltration with bupivacaine, ropivacaine, and lidocaine; scalp block; steroids such as methylprednisolone, triamcinolone, and dexamethasone; ketamine; acetaminophen; ketorolac; liposomal bupivacaine; dexmedetomidine; and performing awake surgery. Postoperative strategies include continuous infusion pumps, wound catheters, and patient-controlled analgesia. Multimodal analgesia may be most effective, with the enhanced recovery after surgery (ERAS) pathway as an example and cognitive-behavioral therapy (CBT) as an adjunct. Patient-specific demographics and clinical factors must be considered in selecting the appropriate approach for a given patient.

Address: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA.; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2210, Chicago, IL 60611, USA. Electronic address: [email protected].

DOI: 10.1016/j.nec.2022.02.004

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MeSH Terms: Analgesics, Non-Narcotic, Analgesics, Opioid, Anesthetics, Local, Brain Neoplasms, Bupivacaine, Humans, Neurosurgery, Pain, Postoperative, Wakefulness