Management of pain following craniotomy

Pain following craniotomy is common, however, achieving effective analgesia can be difficult. The assessment of pain postoperatively can be a challenge in patients who are obtunded (not fully alert) and the severity of pain has historically been underestimated. There are also concerns about side-effects from drugs, particularly with opioids, which may lead to reluctance to administer effective doses. Paracetamol is generally safe and, if given intravenously, provides rapid analgesia, although there are risks associated with overdose and care must be taken to ensure that the safe daily limit is not exceeded. Opioids are effective but side effects of pupillary constriction and respiratory depression may be problematic in the neurosurgical patient. The total use of systemic analgesia can be minimised with the use of regional techniques, such as local anaesthetic nerve blocks. A multimodal technique, using different agents, is most likely to be effective.