Journal
PEDIATRIC ANESTHESIA
Volume 24, Issue 7, Pages 724-733Publisher
WILEY
DOI: 10.1111/pan.12444
Keywords
pain management; analgesics; pediatric; neurosurgery; patient-controlled analgesia; nervous system physiology; age
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Funding
- Jacob and Hilda Blaustein Pain Foundation
- Richard J. Traystman endowed chair
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Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate-to-severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate-to-severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid-induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, 2-adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).
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