PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Craniotomy can lead to intense postoperative pain, especially in the first two days (Santos 2021; Chowdhury 2017; Vacas 2017; Vadivelu 2016). Such poorly controlled pain may aggravate neurosurgical comorbidities and increase the length of hospital stay (Galvin 2019).
The aim of this guideline (Mestdagh 2023) is to provide clinicians with an evidence-based approach to pain management after craniotomy that should improve postoperative pain relief.
The unique PROSPECT methodology is available at https://esraeurope.org/prospect-methodology/. The recommendations are based on a procedure-specific systematic review of randomised controlled trials, systematic reviews and meta-analyses, in which the evidence is critically assessed for current clinical relevance, and efficacy and adverse effects of analgesic techniques. The approach balances the invasiveness of the analgesic interventions with the degree of pain after surgery and considers the use of simple, nonopioid analgesics, such as paracetamol and NSAIDs, as baseline analgesics.
The literature search period was 1 January 2010 to 30 June 2021.
COX, cyclooxygenase; ISI, incision-site infiltration; NSAIDs, non-steroidal anti-inflammatory drugs; SNB, scalp nerve block.
Analgesic interventions that are not recommended for pain management in patients undergoing craniotomy.
NSAIDs, non-steroidal anti-inflammatory drugs.
PROSPECT guideline for craniotomy-infographic