【摘要】 开颅手术后疼痛非常普遍，由于各种原因，其治疗效果尚不理想。就开颅手术后疼痛特点、镇痛现状、各种镇痛方法和药物的选择，以及相关药物优缺点等进行阐述，并对未来研究的发展趋势进行了展望。
Citation： 龚政,熊源长. 开颅手术后疼痛治疗现状及进展. West China Medical Journal, 2010, 25(9): 1769-1772. doi: Copy
| 1. | de Benedittis G, Lorenzetti A, Migliore M, et al. Postoperative pain in neurosurgery: a pilot study in brain surgery[J]. Neurosurgery, 1996, 38(3): 466-469. |
| 2. | 韩如泉, 李学斌, 王保国, 等. 神经外科手术后疼痛的调查[J]. 中华麻醉学杂志, 2001, 21(6): 376-377. |
| 3. | Rahimi SY, Vender JR, Macomson SD, et al. Postoperative pain management after craniotomy: evaluation and cost analysis[J]. Neurosurgery, 2006, 59(4): 852-857. |
| 4. | Quiney N, Cooper R, Stoneham M, et al. Pain after craniotomy: a time for reappraisal[J]? Br J Neurosurg, 1996, 10(3): 295-299. |
| 5. | Basali A, Mascha EJ, Kalfas I, et al. Relation between perioperative hypertension and in racranial hemorrhage after craniotomy[J]. Anesthesiology, 2000, 93(1): 48-54. |
| 6. | Verchère E, Grenier B, Mesli A, et al. Postoperative pain management after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2002, 14(2): 96-101. |
| 7. | Dunbar PJ, Visco E, Lam AM. Craniotomy procedures are associated with less analgesic requirements than other surgical procedures[J]. Anesth Analg, 1999, 88(2): 335-340. |
| 8. | Stoneham MD, Walters FJ. Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists[J]. Eur J Anaesthesiol, 1995, 12(6): 571-575. |
| 9. | Roberts GC. Post-craniotomy analgesia: current practices in British neurosurgical centres--a survey ofpost-craniotomy analgesic practices[J]. Eur J Anaesthesiol, 2005, 22(5): 328-332. |
| 10. | Peón AU, Diccini S. Postoperative pain in craniotomy[J]. Rev Lat Am Enfermagem, 2005, 13(4): 489-495. |
| 11. | Klimek M, Ubben JF, Ammann J, et al. Pain in neurosurgically treated patients: a prospective observational study[J]. J Neurosurg, 2006, 104(3): 350-359. |
| 12. | Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intrcranial surgery[J]. J Neurosurg, 2007, 106(2): 210-216. |
| 13. | Bruder N, Ravussin P. Recovery from anaesthesia and postoperative extubation of neurosurgical patients: a review[J]. J Neurosurg Anaesthesiol, 1999, 11(4): 282-293. |
| 14. | Kawaguchi M, Furuya H, Patel PM. Neuroprotective effects of anaesthetic agents[J]. J Anaesth, 2005, 19(2): 150-156. |
| 15. | Sneyd JR, Andrews CJ, Tsubokawa T. Comparison of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery[J]. Br J Anaesth, 2005, 94: 778-783. |
| 16. | Todd MM, Warner DS, Sokoll MD, et al. A prospective, comparative trial of three anaesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide[J]. Anesthesiology, 1993, 78(6): 1005-1020. |
| 17. | Bala I, Gupta B, Bhardwaj N, et al. Effect of scalp block on postoperative pain relief in craniotomy patients[J]. Anaesth Intensive Care, 2006, 34(2): 224-227. |
| 18. | Pinosky ML, Fishman RL, Reeves ST, et al. The effect of bupivacaine skull block on the hemodynamic response to craniotomy[J]. Anesth Analg, 1996, 83(6): 1256-1261. |
| 19. | Nguyen A, Girard F, Boudreault D, et al. Scalp nerve blocks decrease the severity of pain after craniotomy[J]. Anesth Analg, 2001, 93(5): 1 272-1 276. |
| 20. | Ayoub C, Girard F, Boudreault D, et al. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery[J]. Anesth Analg, 2006, 103(5): 1 237-1 240. |
| 21. | Law-Koune JD, Szekely B, Fermanian C, et al. Scalp infiltration with bupivacaine plus epinephrine or plain ropivacaine reduces postoperative pain after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2005, 17(3): 139-143. |
| 22. | Jellish WS, Leonetti JP, Sawicki K, et al. Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery[J]. Otolaryngol Head Neck Surg, 2006, 135(2): 175-181. |
| 23. | Stoneham MD, Cooper R, Quiney NF, et al. Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate[J]. Anaesthesia, 1996, 51(12): 1176-1178. |
| 24. | Verchere E, Grenier B, Mesli A, et al. Postoperative pain management after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2002, 14(2): 96-101. |
| 25. | Gan TJ, Ginsberg B, Glass PS, et al. Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate[J]. Anesthesiology, 1997, 87(5): 1075-1081. |
| 26. | Barden J, Edwards J, Moore RA, et al. Single dose oral rofecoxib for postoperative pain[J]. Cochrane Database Syst Rev, 2005, 25(1): CD004604. |
| 27. | Jones SJ, Cormack J, Murphy MA, et al. Parecoxib for analgesia after craniotomy[J]. Br J Anaesth, 2009, 102(1): 76-79. |
| 28. | Sakaguchi Y, Takahashi S. Dexmedetomidine[J]. Masui, 2006, 55(7): 856-863. |
| 29. | Souter MJ, Rozet I, Ojemann JG, et al. Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography[J]. J Neurosurg Anesthesiol, 2007, 19(1): 38-44. |
| 30. | Sato K, Kamii H, Shimizu H, et al. Preoperative sedation with dexmedetomidine in patients with aneurysmal subarachnoid hemorrhage[J]. Masui, 2006, 55(1): 51-54. |
| 31. | Arain SR, Ruehlow RM, Uhrich TD, et al. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery[J]. Anesth Analg, 2004, 98(1): 153-158. |
| 32. | Agarwal A, Sinha PK, Pandey CM, et al. Effect of a subanaesthetic dose of intravenous ketamine and/or local anaesthetic infiltration on hemodynamic responses to skull-pin placement: a prospective, placebocontrolled, randomized, double-blind study[J]. J Neurosurg Anaesthesiol, 2001, 13(3): 189-194. |
| 33. | Helmy SA, Bali A. The effect of the preemptive use of the NMDA receptor antagonist dextromethorphan on postoperative analgesic requirements[J]. Anesth Analg, 2001, 92(3): 739-744. |
| 34. | Gottschalk A, Yaster M. The perioperative management of pain from intracranial surgery[J]. Neurocrit Care, 2009, 10(3): 387-402. |
- 1. de Benedittis G, Lorenzetti A, Migliore M, et al. Postoperative pain in neurosurgery: a pilot study in brain surgery[J]. Neurosurgery, 1996, 38(3): 466-469.
- 2. 韩如泉, 李学斌, 王保国, 等. 神经外科手术后疼痛的调查[J]. 中华麻醉学杂志, 2001, 21(6): 376-377.
- 3. Rahimi SY, Vender JR, Macomson SD, et al. Postoperative pain management after craniotomy: evaluation and cost analysis[J]. Neurosurgery, 2006, 59(4): 852-857.
- 4. Quiney N, Cooper R, Stoneham M, et al. Pain after craniotomy: a time for reappraisal[J]? Br J Neurosurg, 1996, 10(3): 295-299.
- 5. Basali A, Mascha EJ, Kalfas I, et al. Relation between perioperative hypertension and in racranial hemorrhage after craniotomy[J]. Anesthesiology, 2000, 93(1): 48-54.
- 6. Verchère E, Grenier B, Mesli A, et al. Postoperative pain management after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2002, 14(2): 96-101.
- 7. Dunbar PJ, Visco E, Lam AM. Craniotomy procedures are associated with less analgesic requirements than other surgical procedures[J]. Anesth Analg, 1999, 88(2): 335-340.
- 8. Stoneham MD, Walters FJ. Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists[J]. Eur J Anaesthesiol, 1995, 12(6): 571-575.
- 9. Roberts GC. Post-craniotomy analgesia: current practices in British neurosurgical centres--a survey ofpost-craniotomy analgesic practices[J]. Eur J Anaesthesiol, 2005, 22(5): 328-332.
- 10. Peón AU, Diccini S. Postoperative pain in craniotomy[J]. Rev Lat Am Enfermagem, 2005, 13(4): 489-495.
- 11. Klimek M, Ubben JF, Ammann J, et al. Pain in neurosurgically treated patients: a prospective observational study[J]. J Neurosurg, 2006, 104(3): 350-359.
- 12. Gottschalk A, Berkow LC, Stevens RD, et al. Prospective evaluation of pain and analgesic use following major elective intrcranial surgery[J]. J Neurosurg, 2007, 106(2): 210-216.
- 13. Bruder N, Ravussin P. Recovery from anaesthesia and postoperative extubation of neurosurgical patients: a review[J]. J Neurosurg Anaesthesiol, 1999, 11(4): 282-293.
- 14. Kawaguchi M, Furuya H, Patel PM. Neuroprotective effects of anaesthetic agents[J]. J Anaesth, 2005, 19(2): 150-156.
- 15. Sneyd JR, Andrews CJ, Tsubokawa T. Comparison of propofol/remifentanil and sevoflurane/remifentanil for maintenance of anaesthesia for elective intracranial surgery[J]. Br J Anaesth, 2005, 94: 778-783.
- 16. Todd MM, Warner DS, Sokoll MD, et al. A prospective, comparative trial of three anaesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide[J]. Anesthesiology, 1993, 78(6): 1005-1020.
- 17. Bala I, Gupta B, Bhardwaj N, et al. Effect of scalp block on postoperative pain relief in craniotomy patients[J]. Anaesth Intensive Care, 2006, 34(2): 224-227.
- 18. Pinosky ML, Fishman RL, Reeves ST, et al. The effect of bupivacaine skull block on the hemodynamic response to craniotomy[J]. Anesth Analg, 1996, 83(6): 1256-1261.
- 19. Nguyen A, Girard F, Boudreault D, et al. Scalp nerve blocks decrease the severity of pain after craniotomy[J]. Anesth Analg, 2001, 93(5): 1 272-1 276.
- 20. Ayoub C, Girard F, Boudreault D, et al. A comparison between scalp nerve block and morphine for transitional analgesia after remifentanil-based anesthesia in neurosurgery[J]. Anesth Analg, 2006, 103(5): 1 237-1 240.
- 21. Law-Koune JD, Szekely B, Fermanian C, et al. Scalp infiltration with bupivacaine plus epinephrine or plain ropivacaine reduces postoperative pain after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2005, 17(3): 139-143.
- 22. Jellish WS, Leonetti JP, Sawicki K, et al. Morphine/ondansetron PCA for postoperative pain, nausea, and vomiting after skull base surgery[J]. Otolaryngol Head Neck Surg, 2006, 135(2): 175-181.
- 23. Stoneham MD, Cooper R, Quiney NF, et al. Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate[J]. Anaesthesia, 1996, 51(12): 1176-1178.
- 24. Verchere E, Grenier B, Mesli A, et al. Postoperative pain management after supratentorial craniotomy[J]. J Neurosurg Anesthesiol, 2002, 14(2): 96-101.
- 25. Gan TJ, Ginsberg B, Glass PS, et al. Opioid-sparing effects of a low-dose infusion of naloxone in patient-administered morphine sulfate[J]. Anesthesiology, 1997, 87(5): 1075-1081.
- 26. Barden J, Edwards J, Moore RA, et al. Single dose oral rofecoxib for postoperative pain[J]. Cochrane Database Syst Rev, 2005, 25(1): CD004604.
- 27. Jones SJ, Cormack J, Murphy MA, et al. Parecoxib for analgesia after craniotomy[J]. Br J Anaesth, 2009, 102(1): 76-79.
- 28. Sakaguchi Y, Takahashi S. Dexmedetomidine[J]. Masui, 2006, 55(7): 856-863.
- 29. Souter MJ, Rozet I, Ojemann JG, et al. Dexmedetomidine sedation during awake craniotomy for seizure resection: effects on electrocorticography[J]. J Neurosurg Anesthesiol, 2007, 19(1): 38-44.
- 30. Sato K, Kamii H, Shimizu H, et al. Preoperative sedation with dexmedetomidine in patients with aneurysmal subarachnoid hemorrhage[J]. Masui, 2006, 55(1): 51-54.
- 31. Arain SR, Ruehlow RM, Uhrich TD, et al. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery[J]. Anesth Analg, 2004, 98(1): 153-158.
- 32. Agarwal A, Sinha PK, Pandey CM, et al. Effect of a subanaesthetic dose of intravenous ketamine and/or local anaesthetic infiltration on hemodynamic responses to skull-pin placement: a prospective, placebocontrolled, randomized, double-blind study[J]. J Neurosurg Anaesthesiol, 2001, 13(3): 189-194.
- 33. Helmy SA, Bali A. The effect of the preemptive use of the NMDA receptor antagonist dextromethorphan on postoperative analgesic requirements[J]. Anesth Analg, 2001, 92(3): 739-744.
- 34. Gottschalk A, Yaster M. The perioperative management of pain from intracranial surgery[J]. Neurocrit Care, 2009, 10(3): 387-402.