Pain Management and Outcomes in Patients Undergoing Craniotomy : A Scoping Review.
Keywords:
Pain management, outcomes of pain management, Patients Undergoing Craniotomy, scoping review, multimodal analgesiaAbstract
This scoping review aimed to explore, collect, and synthesize empirical evidence regarding pain management strategies and their clinical outcomes in patients undergoing craniotomy.
Methods: The study was conducted following the Arksey and O'Malley framework (2005) and the PRISMA-ScR guidelines. Data were systematically searched through electronic databases, including SciSpace, Google Scholar, PubMed, and ThaiJo, covering the period from 2016 to 2025. A total of 30 studies met the inclusion criteria.
Results: The majority of the studies were randomized controlled trials (RCTs) (59.94%), followed by meta-analyses (23.31%). Regarding pain management strategies, multimodal analgesia was the predominant approach, particularly the combination of local anesthesia and systemic analgesics (73.26%), which demonstrated higher efficacy than opioid-only regimens. Evidence strongly supported the use of local anesthesia techniques, specifically scalp nerve blocks and scalp infiltration, primarily utilizing ropivacaine and bupivacaine. The most frequently used non-opioid medications were paracetamol/acetaminophen (56.61%) and NSAIDs (30.00%), while common adjuvant medications included dexmedetomidine (29.97%) and gabapentinoids (16.55%). Furthermore, the integration of Enhanced Recovery After Surgery (ERAS) protocols and complementary therapies, such as P6 acupoint stimulation, was found to reduce postoperative nausea, vomiting, and pain. Additionally, music therapy was identified as an effective intervention for reducing anxiety and influencing pain perception in patients.
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