ABSTRACT
Acute postoperative pain occurs within the first 24–48 h after a craniotomy. This pain, if severe and untreated, may lead to sympathetic stimulation and may precipitate secondary intracranial hemorrhage. Patients having postoperative pain are usually presumed to have a lower intensity of pain due to lesser number of pain receptors in the dura, pain insensitivity of the brain, and reduced pain fiber density along the incision lines. Postcraniotomy pain is superficial in character, suggesting a somatic rather than a visceral origin. The pain mainly originates from the pericranial muscles and soft tissues. The highest incidence of pain is seen in suboccipital and subtemporal craniotomies. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative pain relief mainly after a craniotomy may lead to: platelet dysfunction and risk of bleeding, altered myocardial function, and renal toxicity. This chapter also summarizes commonly used drugs and their doses for perioperative pain management in the pediatric neurosurgical population.
