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Updated: Jan 12, 2026

Intracranial Pharmacotherapy and Pain Assays in Rodents

Intracranial Pharmacotherapy and Pain Assays in Rodents

Published on: April 9, 2019

Multimodal analgesia for craniotomy.

Vin Shen Ban¹, Ravi Bhoja², David L McDonagh^1,2,3

¹Department of Neurological Surgery.

Current Opinion in Anaesthesiology

|July 16, 2019

Summary

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Multimodal analgesia, including acetaminophen, gabapentinoids, and scalp blocks, offers improved pain control after cranial surgery while minimizing opioid use. Further research is needed for other agents like NSAIDs and ketamine.

Area of Science:

Anesthesiology
Neurosurgery
Pain Management

Background:

Postcraniotomy pain management is complex, requiring effective analgesia without compromising neurological assessment.
Traditional opioid-based approaches are often insufficient and associated with significant side effects.
Multimodal analgesia strategies have shown promise in other surgical fields.

Purpose of the Study:

To review the evidence supporting and opposing the use of various components of multimodal analgesia in cranial neurosurgery.
To guide the integration of effective pain management strategies into perioperative care for craniotomy patients.

Main Methods:

Systematic review of current literature on multimodal analgesia components in cranial surgery.
Analysis of data regarding efficacy, safety, and impact on neurological examination.

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Main Results:

Acetaminophen and gabapentinoids show benefit pre- and postoperatively, with gabapentinoids potentially reducing nausea.
Scalp blocks offer moderate evidence of superior analgesia compared to incisional infiltration.
Intraoperative dexmedetomidine reduces opioid needs and postcraniotomy hypertension.
Evidence for methocarbamol, NSAIDs, ketamine, and IV lidocaine in this population is limited.

Conclusions:

Minimizing opioid use is crucial for postcraniotomy pain.
A multimodal approach is increasingly supported by evidence.
Gabapentin, acetaminophen, dexmedetomidine, and scalp blocks are recommended based on current data.
Further research is required to establish optimal use of NSAIDs, ketamine, and other agents.