Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists

As part of an evaluation of post-operative analgesia for craniotomy patients, a postal questionnaire was sent to 183 consultant members of the Neuroanaesthesia Society of Great Britain and Ireland, inquiring about their current practices for post-operative neurosurgical analgesia. Replies were received from 110 neuroanaesthetists in 37 different neurosurgical centres. Intramuscular codeine phosphate or dihydrocodeine was the mainstay of post-operative analgesia for 97% of neuroanaesthetists despite the fact that over half of them thought that analgesia was inadequate. Only four neuroanaesthetists would ever consider using opioids post-operatively because of fears about respiratory depression and sedation, yet all except one used opioids per-operatively. Post-operative analgesia for craniotomy patients is perceived as inadequate by most neuroanaesthetists, yet traditional prejudice against opioid use prevents this being remedied. We suggest that patient-controlled analgesia with morphine could be a safe alternative to codeine phosphate.