Vacas Susana, Van de Wiele Barbara
Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, UCLA, Los Angeles, California, USA.
Surg Neurol Int. 2017 Dec 6;8:291. doi: 10.4103/sni.sni_301_17. eCollection 2017.
Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs.
This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols.
Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care.
Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes.
开颅手术是一种相对常见的外科手术，术后疼痛发生率较高。制定标准化的疼痛管理和术后加速康复（ERAS）方案对于优化手术效果、提高患者满意度以及降低医疗成本而言是必要且至关重要的。
这项工作基于对来自PubMed、Cochrane中心注册库和谷歌学术的已发表手稿（1996年至2017年）进行的文献检索。它旨在综合并回顾我们目前对开颅术后疼痛及其在神经外科ERAS方案中作用的科学认识。
减轻开颅手术疼痛的策略需要在患者护理的各个阶段进行干预：术前、术中和术后干预。疼痛管理应在围手术期从风险评估、患者教育和术前用药开始。在手术期间，麻醉技术的改进、阿片类药物、对乙酰氨基酚和非甾体抗炎药（NSAIDs）的选择、区域技术、右美托咪定、氯胺酮、利多卡因、皮质类固醇以及多学科沟通都是需要考虑并可能采用的策略。阿片类药物仍然是缓解疼痛的主要手段，但患者自控镇痛、NSAIDs、疼痛管理的标准化、生物/行为干预、头部敷料的改进以及以患者为中心的管理都是可能改善患者护理的有益方法。
未来对机制、预测因素、治疗方法和疼痛管理途径的研究将有助于确定优化疼痛效果的干预措施组合。
