A review of the efficacy and safety of opioid analgesics post-craniotomy.

--Codeine phosphate is the most commonly used analgesic post-craniotomy. --It is argued, in this paper, that codeine phosphate is an unpredictable pro-drug that does not equate to a safe and effective method of providing analgesia post-craniotomy. --Lack of evidence supporting tramadol's usage and concerns over its interactions and side effects mean its use cannot be advocated. --The traditional justification for withholding morphine in post-craniotomy pain appears to be largely based on anecdotal evidence. --Raising awareness among critical care nurses of the pharmacological properties of the analgesics used is imperative, if post-craniotomy pain is to be adequately treated. --There is an explicit challenge to the neurosurgical community to re-evaluate their pain-management strategies in the post-craniotomy patient.