Post Awake Craniotomy Care <Postoperative Care, Pain, Seizures, Postoperative Nausea and Vomiting>

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References

  1. Kwinta BM, Myszka AM, Bigaj MM, Krzyżewski RM, Starowicz-Filip A. Intra- and postoperative adverse events in awake craniotomy for intrinsic supratentorial brain tumors. Neurol Sci. 2021;42:1437–41.

    PubMed  Google Scholar 

  2. Gerritsen JKW, Viëtor CL, Rizopoulos D, Schouten JW, Klimek M, Dirven CMF, Vincent AJPE. Awake craniotomy versus craniotomy under general anesthesia without surgery adjuncts for supratentorial glioblastoma in eloquent areas: a retrospective matched case-control study. Acta Neurochir. 2019;161:307–15.

    PubMed  Google Scholar 

  3. Richardson AM, McCarthy DJ, Sandhu J, Mayrand R, Guerrero C, Rosenberg C, Gernsback JE, Komotar R, Ivan M. Predictors of successful discharge of patients on postoperative day 1 after craniotomy for brain tumor. World Neurosurg. 2019;126:e869–77.

    PubMed  Google Scholar 

  4. Takami H, Venkatraghavan L, Bernstein M. Perioperative factors affecting readmission after awake craniotomy: analysis of 609 consecutive cases. World Neurosurg. 2021;134:1631. https://doi.org/10.1016/J.WNEU.2021.11.010.

    Article  Google Scholar 

  5. Trinh VT, Fahim DK, Shah K, Tummala S, McCutcheon IE, Sawaya R, Suki D, Prabhu SS. Subcortical injury is an independent predictor of worsening neurological deficits following awake craniotomy procedures. Neurosurgery. 2013;72:160–9.

    PubMed  Google Scholar 

  6. Nossek E, Matot I, Shahar T, Barzilai O, Rapoport Y, Gonen T, Sela G, Korn A, Hayat D, Ram Z. Failed awake craniotomy: a retrospective analysis in 424 patients undergoing craniotomy for brain tumor. J Neurosurg. 2013;118:243–9.

    PubMed  Google Scholar 

  7. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–8.

    PubMed  Google Scholar 

  8. Hagan KB, Bhavsar S, Raza SM, et al. Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016;24:10–6.

    PubMed  Google Scholar 

  9. Wang L, Cai H, Wang Y, Liu J, Chen T, Liu J, Huang J, Guo Q, Zou W. Enhanced recovery after elective craniotomy: a randomized controlled trial. J Clin Anesth. 2022;76:110575. https://doi.org/10.1016/J.JCLINANE.2021.110575.

    Article  PubMed  Google Scholar 

  10. Jun CY, Nie C, Lu H, Zhang L, Lin CH, Yong WS, Li W, Shen S, Wang H. Monitored anesthetic care combined with scalp nerve block in awake craniotomy: an effective attempt at enhanced recovery after neurosurgery. World Neurosurg. 2021;154:e509–19.

    Google Scholar 

  11. Bojaxhi E, Louie C, ReFaey K, Gruenbaum SE, Leone BJ, Bechtel P, Barbosa MP, Chaichana KL, Quinones-Hinojosa A. Reduced pain and opioid use in the early postoperative period in patients undergoing a frontotemporal craniotomy under regional vs general anesthesia. World Neurosurg. 2021;150:e31–7.

    PubMed  Google Scholar 

  12. Eseonu CI, Rincon-Torroella J, ReFaey K, Lee YM, Nangiana J, Vivas-Buitrago T, Quiñones-Hinojosa A. Awake craniotomy vs craniotomy under general anesthesia for perirolandic gliomas: evaluating perioperative complications and extent of resection. Neurosurgery. 2017;81:481–9.

    PubMed  Google Scholar 

  13. Mordhorst C, Latz B, Kerz T, Wisser G, Schmidt A, Schneider A, Jahn-Eimermacher A, Werner C, Engelhard K. Prospective assessment of postoperative pain after craniotomy. J Neurosurg Anesthesiol. 2010;22:202–6.

    PubMed  Google Scholar 

  14. Thibault M, Girard F, Moumdjian R, Chouinard P, Boudreault D, Ruel M. Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study. Can J Anaesth. 2007;54:544–8.

    PubMed  Google Scholar 

  15. Bronco A, Pietrini D, Lamperti M, et al. Incidence of pain after craniotomy in children. Paediatr Anaesth. 2014;24:781–7.

    PubMed  Google Scholar 

  16. Bala I, Gupta B, Vhardwaj N, Ghai B, Khosla VK. Effect of scalp block on postoperative pain relief in craniotomy patients. Anaesth Intensive Care. 2006;34:224–7.

    CAS  PubMed  Google Scholar 

  17. Guilfoyle MR, Helmy A, Duane D, Hutchinson PJA. Regional scalp block for postcraniotomy analgesia: a systematic review and meta-analysis. Anesth Analg. 2013;116:1093–102.

    PubMed  Google Scholar 

  18. Ayoub C, Girard F, Boudreault D, Chouinard P, Ruel M, Moumdjian R. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery. Anesth Analg. 2006;103:1237–40.

    CAS  PubMed  Google Scholar 

  19. Costello TG, Cormack JR, Mather LE, LaFerlita B, Murphy MA, Harris K. Plasma levobupivacaine concentrations following scalp block in patients undergoing awake craniotomy. Br J Anaesth. 2005;94:848–51.

    CAS  PubMed  Google Scholar 

  20. Nguyen A, Girard F, Boudreault D, Fugère F, Ruel M, Moumdjian R, Bouthilier A, Caron JL, Bojanowski MW, Girard DC. Scalp nerve blocks decrease the severity of pain after craniotomy. Anesth Analg. 2001;93:1272–6.

    CAS  PubMed  Google Scholar 

  21. Akhigbe T, Zolnourian A. Use of regional scalp block for pain management after craniotomy: review of literature and critical appraisal of evidence. J Clin Neurosci. 2017;45:44–7.

    CAS  PubMed  Google Scholar 

  22. Song J, Ji Q, Sun Q, Gao T, Liu K, Li L. The opioid-sparing effect of intraoperative dexmedetomidine infusion after craniotomy. J Neurosurg Anesthesiol. 2016;28:14–20.

    PubMed  Google Scholar 

  23. Sivakumar W, Jensen M, Martinez J, Tanana M, Duncan N, Hoesch R, Riva-Cambrin JK, Kilburg C, Ansari S, House PA. Intravenous acetaminophen for postoperative supratentorial craniotomy pain: a prospective, randomized, double-blinded, placebo-controlled trial. J Neurosurg. 2018;130:766–72.

    PubMed  Google Scholar 

  24. Artime CA, Aijazi H, Zhang H, Syed T, Cai C, Gumbert SD, Ferrario L, Normand KC, Williams GW, Hagberg CA. Scheduled intravenous acetaminophen improves patient satisfaction with Postcraniotomy pain management: a prospective, randomized, placebo-controlled, double-blind study. J Neurosurg Anesthesiol. 2018;30:231–6.

    PubMed  PubMed Central  Google Scholar 

  25. Ebada MA, Ali AS, Elshakankiry A, et al. Should intravenous acetaminophen be considered for post craniotomy pain management? A meta-analysis of randomized controlled trials. J Neurosurg Sci. 2021;66:413–9. https://doi.org/10.23736/S0390-5616.21.05402-3.

    Article  PubMed  Google Scholar 

  26. Rahimi SY, Vender JR, Macomson SD, French A, Smith JR, Alleyne CH. Postoperative pain management after craniotomy: evaluation and cost analysis. Neurosurgery. 2006;59:852–7.

    PubMed  Google Scholar 

  27. Williams DL, Pemberton E, Leslie K. Effect of intravenous parecoxib on post-craniotomy pain. Br J Anaesth. 2011;107:398–403.

    CAS  PubMed  Google Scholar 

  28. Rajkiran R, Lal Soni S, Jangra K, Bhagat H, Singh A, Singh A, Panda NB, Kaloria N. Diclofenac is superior to paracetamol in postoperative pain scores and analgesic consumption in supratentorial craniotomy with no difference in platelet and clot function: a prospective randomized controlled trial. J Neurosurg Anesthesiol. 2021;34(3):321–6. https://doi.org/10.1097/ANA.0000000000000765.

    Article  PubMed  Google Scholar 

  29. Grossman R, Ram Z, Perel A, Yusim Y, Zaslansky R, Berkenstadt H. Control of postoperative pain after awake craniotomy with local intradermal analgesia and metamizol. Isr Med Assoc J. 2007;9:380–2.

    CAS  PubMed  Google Scholar 

  30. Dilmen OK, Akcil EF, Tunali Y, Karabulut ES, Bahar M, Altindas F, Vehid H, Yentur E. Postoperative analgesia for supratentorial craniotomy. Clin Neurol Neurosurg. 2016;146:90–5.

    PubMed  Google Scholar 

  31. Yadav G, Choupoo S, Das SK, Das SK, Behera SS, Khuba S, Mishra LD, Singh DK. Evaluating the role of flupirtine for postcraniotomy pain and compare it with diclofenac sodium: a prospective, randomized, double blind, placebo-controlled study. J Neurosurg Anesthesiol. 2014;26:32–6.

    PubMed  Google Scholar 

  32. Yadav G, Jain G, Singh M. Role of flupirtine in reducing preoperative anxiety of patients undergoing craniotomy procedure. Saudi J Anaesth. 2017;11:158–62.

    PubMed  PubMed Central  Google Scholar 

  33. Calandre EP, Rico-Villademoros F, Slim M. Alpha2delta ligands, gabapentin, pregabalin and mirogabalin: a review of their clinical pharmacology and therapeutic use. Expert Rev Neurother. 2016;16:1263–77. https://doi.org/10.1080/1473717520161202764.

    Article  CAS  PubMed  Google Scholar 

  34. Zeng M, Dong J, Lin N, Zhang W, Zhang K, Peng K, Wang D, Zhao Y, Peng Y, Han R. Preoperative gabapentin administration improves acute postoperative analgesia in patients undergoing craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol. 2019;31:392–8.

    PubMed  Google Scholar 

  35. Misra S, Parthasarathi G, Vilanilam GC. The effect of gabapentin premedication on postoperative nausea, vomiting, and pain in patients on preoperative dexamethasone undergoing craniotomy for intracranial tumors. J Neurosurg Anesthesiol. 2013;25:386–91.

    PubMed  Google Scholar 

  36. Bockbrader HN, Wesche D, Miller R, Chapel S, Janiczek N, Burger P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2012;49(10):661–9.

    Google Scholar 

  37. Shimony N, Amit U, Minz B, Grossman R, Dany MA, Gonen L, Kandov K, Ram Z, Weinbroum AA. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125:1513–22.

    CAS  PubMed  Google Scholar 

  38. Lamsal R, Mahajan C, Chauhan V, Gupta N, Mishra N, Rath GP. Effect of pregabalin on postcraniotomy pain in patients undergoing supratentorial tumor surgery: a randomized, double-blind, placebo-controlled trial. J Neurosci Rural Pract. 2019;10:641.

    PubMed  PubMed Central  Google Scholar 

  39. Elrashidy A, Khattab AM, Elseify ZA, Oriby ME. Perioperative anxiolytic and analgesic effects of Pregabalin in Vitreo-retinal surgery: a randomized, double-blind study. Anesth Pain Med. 2021;11(4):e117414. https://doi.org/10.5812/AAPM.117414.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Sudheer PS, Logan SW, Terblanche C, Ateleanu B, Hall JE. Comparison of the analgesic efficacy and respiratory effects of morphine, tramadol and codeine after craniotomy. Anaesthesia. 2007;62:555–60.

    CAS  PubMed  Google Scholar 

  41. Warren DT, Bowen-Roberts T, Ou C, Purdy R, Steinbok P. Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting. Childs Nerv Syst. 2010;26:1535–41.

    PubMed  Google Scholar 

  42. Gardner JS, Blough D, Drinkard CR, Shatin D, Anderson G, Graham D, Alderfer R. Tramadol and seizures: a surveillance study in a managed care population. Pharmacotherapy. 2000;20:1423–31.

    CAS  PubMed  Google Scholar 

  43. Verchère E, Grenier B, Mesli A, Siao D, Sesay M, Maurette P. Postoperative pain management after supratentorial craniotomy. J Neurosurg Anesthesiol. 2002;14:96–101.

    PubMed  Google Scholar 

  44. Ijaz MK, Moore M. Remifentanil patient-controlled analgesia in awake craniotomy: an introduction of an innovative technique. J Neurosurg Anesthesiol. 2020;32:367.

    PubMed  Google Scholar 

  45. Darmawikarta D, Sourour M, Couban R, Kamath S, Reddy KKV, Shanthanna H. Opioid-free analgesia for supratentorial craniotomies: a systematic review. Can J Neurol Sci. 2019;46:415–22.

    PubMed  Google Scholar 

  46. Patel KS, Laiwalla AN, DiCesare JAT, Garrett MC, Wang AC. Subcutaneous sumatriptan: association with decreases in postoperative pain and opioid use after elective cranial surgery. J Neurosurg. 2020;134:401–9.

    Google Scholar 

  47. Licina A, Russell J, Silvers A, ** X, Denny J. Subcutaneous sumatriptan for the treatment of postcraniotomy pain (SUPS trial): protocol for a randomised double-blinded placebo controlled trial. BMJ Open. 2019;9:e032388. https://doi.org/10.1136/BMJOPEN-2019-032388.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Venkatraghavan L, Li L, Bailey T, Manninen PH, Tymianski M. Sumatriptan improves postoperative quality of recovery and reduces postcraniotomy headache after cranial nerve decompression. Br J Anaesth. 2016;117:73–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Fabling JM, Gan TJ, El-Moalem HE, Warner DS, Borel CO. A randomized, double-blinded comparison of ondansetron, droperidol, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. Anesth Analg. 2000;91:358–61.

    CAS  PubMed  Google Scholar 

  50. Fabling JM, Gan TJ, Guy J, Borel CO, El-Moalem HE, Warner DS. Postoperative nausea and vomiting: a retrospective analysis. J Neurosurg Anesthesiol. 1997;9(4):308–12. https://journals.lww.com/jnsa/Abstract/1997/10000/Postoperative_Nausea_and_Vomiting__A_Retrospective.3.aspx. Accessed 1 Feb 2022.

    CAS  PubMed  Google Scholar 

  51. Ouyang MW, McDonagh DL, Phillips-Bute B, James ML, Friedman AH, Gan TJ. Comparison of postoperative nausea between benign and malignant brain tumor patients undergoing awake craniotomy: a retrospective analysis. Curr Med Res Opin. 2013;29:1039–44.

    CAS  PubMed  Google Scholar 

  52. Manninen PH, Tan TK. Postoperative nausea and vomiting after craniotomy for tumor surgery: a comparison between awake craniotomy and general anesthesia. J Clin Anesth. 2002;14:279–83.

    PubMed  Google Scholar 

  53. Kamata K, Morioka N, Maruyama T, Komayama N, Nitta M, Muragaki Y, Kawamata T, Ozaki M. The effect of single low-dose dexamethasone on vomiting during awake craniotomy. J Anesth. 2016;30:941–8.

    PubMed  Google Scholar 

  54. Jain V, Mitra JK, Rath GP, Prabhakar H, Bithal PK, Dash HH. A randomized, double-blinded comparison of ondansetron, granisetron, and placebo for prevention of postoperative nausea and vomiting after supratentorial craniotomy. J Neurosurg Anesthesiol. 2009;21:226–30.

    PubMed  Google Scholar 

  55. Knape JTA, Adriaensen H, Van Aken H, Blunnie WP, Carlsson C, Dupont M, Pasch T. Scheduled prophylactic ondansetron administration did not improve its antiemetic efficacy after intracranial tumour resection surgery in children. Eur J Anaesthesiol. 2007;24:563–7.

    CAS  PubMed  Google Scholar 

  56. Lee A, Chan SKC, Fan LTY. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015;2016:CD003281. https://doi.org/10.1002/14651858.CD003281.PUB4.

    Article  Google Scholar 

  57. Kahlenberg CA, Fadul CE, Roberts DW, Thadani VM, Bujarski KA, Scott RC, Jobst BC. Seizure prognosis of patients with low-grade tumors. Seizure. 2012;21:540–5.

    PubMed  Google Scholar 

  58. Dewan MC, White-Dzuro GA, Brinson PR, Thompson RC, Chambless LB. Perioperative seizure in patients with glioma is associated with longer hospitalization, higher readmission, and decreased overall survival. J Neurosurg. 2016;125:1033–41.

    PubMed  Google Scholar 

  59. Klimek M, Dammers R. Antiepileptic drug therapy in the perioperative course of neurosurgical patients. Curr Opin Anaesthesiol. 2010;23:564–7.

    PubMed  Google Scholar 

  60. Gonen T, Grossman R, Sitt R, Nossek E, Yanaki R, Cagnano E, Korn A, Hayat D, Ram Z. Tumor location and IDH1 mutation may predict intraoperative seizures during awake craniotomy. J Neurosurg. 2014;121:1133–8.

    PubMed  Google Scholar 

  61. Greenhalgh J, Weston J, Dundar Y, Nevitt SJ, Marson AG. Antiepileptic drugs as prophylaxis for postcraniotomy seizures. Cochrane Database Syst Rev. 2020;4:CD007286. https://doi.org/10.1002/14651858.CD007286.PUB5.

    Article  PubMed  Google Scholar 

  62. Eseonu CI, Eguia F, Garcia O, Kaplan PW, Quiñones-Hinojosa A. Comparative analysis of monotherapy versus duotherapy antiseizure drug management for postoperative seizure control in patients undergoing an awake craniotomy. J Neurosurg. 2018;128:1661–7.

    PubMed  Google Scholar 

  63. Pourzitaki C, Tsaousi G, Apostolidou E, Karakoulas K, Kouvelas D, Amaniti E. Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(1):315–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Klimek M, van der Horst PH, Hoeks SE, Stolker RJ. Quality and quantity of memories in patients who undergo awake brain tumor resection. World Neurosurg. 2018;109:e258–64.

    PubMed  Google Scholar 

  65. Elayat A, Jena SS, Nayak S, Sahu RN, Tripathy S. Enhanced recovery after surgery—ERAS in elective craniotomies-a non-randomized controlled trial. BMC Neurol. 2021;21:127. https://doi.org/10.1186/S12883-021-02150-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Wang Y, Xue YF, Zhao BF, Guo SC, Ji PG, Liu JH, Wang N, Chen F, Zhai YL, Wang Y, Xue YR. Real-world implementation of neurosurgical enhanced recovery after surgery (ERAS) protocol for glioma patients undergoing elective craniotomy. Front Oncol. 2022;12:860257.

    PubMed  PubMed Central  Google Scholar 

  67. Sanghvi D. Post-treatment imaging of high-grade gliomas. Indian J Radiol Imaging. 2015;25(02):102–8.

    PubMed  PubMed Central  Google Scholar 

  68. Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postma TJ, Van Den Bent MJ, Beute GN, Enting RH, Kappelle AC, Boogerd W. Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol. 2009;27(22):3712–22.

    PubMed  Google Scholar 

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Krzyzewski, R.M., Albuquerque, L.A.F. (2023). Post Awake Craniotomy Care <Postoperative Care, Pain, Seizures, Postoperative Nausea and Vomiting>. In: Pour-Rashidi, A., Aarabi, J. (eds) The Principles of Successful Awake Craniotomy. Springer, Singapore. https://doi.org/10.1007/978-981-99-2985-6_8

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