It is now recognized that a significant number of patients suffer moderate or severe pain after craniotomy. There is a tendency to avoid morphine for post-operative analgesia in craniotomy patients for fear of respiratory depression leading to hypercapnia and excessive sedation and because it may interfere with the assessment of the size and reactivity of the pupils. However, morphine appears to be safe and provides more effective analgesia than codeine in post-craniotomy patients . Patient-controlled analgesia (PCA) with morphine may be better for patients with normal levels of consciousness.
Non-steroidal anti-inflammatory drugs (NSAIDs) can be a useful adjunct for post-operative pain control. However, NSAIDs have some well-known adverse effects, including effects on platelet function and renal function, and may increase CBF . Further studies comparing the efficacy and safety of different analgesic regimens in craniotomy patients are needed.
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