Cochrane · systematic review · CD011931
Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery
Galvin, IM, Levy, R, Day, AG, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
AnaesthesiaAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
66
current version
GRADE rated
44
No studies
22
Included studies
NR
No studies 22 · 33.3%Ungraded 0 · 0%Very low 14 · 21.2%Low 18 · 27.3%Moderate 7 · 10.6%High 5 · 7.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Nonsteroidal anti‐inflammatory drugs (NSAIDs) compared with control or placebo medications for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative pain 0 to 6 hours (Score 0 to 10, VAS or NRS Scale) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 6 studies · 742 participants | High |
Acute postoperative pain at 12 hours (Score 0 to 10, VAS or NRS Scale) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 6 studies · 742 participants | High |
Acute postoperative pain at 24 hours (Score 0 to 10, VAS or NRS Scale) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 6 studies · 742 participants | High |
Acute postoperative pain at 48 hours (Score 0 to 10, VAS or NRS Scale) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 1 study · 149 participants | Very low Downgraded: imprecision |
Additional analgesia requirements 0 to 24 hours (Milligrams) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 4 studies · 265 participants | Low Downgraded: imprecision |
Analgesic Success Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | NR | Very low Downgraded: imprecision |
Sedation Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | NR | No studies |
Chronic Headache Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | NR | No studies |
Length of critical care stay (hours) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | NR | No studies |
Length of hospital stay (hours) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | NR | No studies |
Adverse event nausea and vomiting (0 to 24 hours) Nonsteroidal anti‐inflammatory drugs (NSAIDs) vs control or placebo medications | no estimate extracted | 2 studies · 345 participants | Low Downgraded: imprecision |
Dexmedetomidine compared with control or placebo medications for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative pain 0 to 6 hours (Score 0 to 10, VAS or NRS Scale) Dexmedetomidine vs control or placebo medications | no estimate extracted | 2 studies · 128 participants | Moderate Downgraded: imprecision, inconsistency |
Acute postoperative pain at 12 hours (Score 0 to 10, VAS or NRS Scale) Dexmedetomidine vs control or placebo medications | no estimate extracted | 2 studies · 128 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 24 hours (Score 0 to 10, VAS or NRS Scale) Dexmedetomidine vs control or placebo medications | no estimate extracted | 2 studies · 128 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 48 hours Dexmedetomidine vs control or placebo medications | no estimate extracted | NR | No studies |
Additional analgesia requirements 0 to 24 hours (Milligrams) Dexmedetomidine vs control or placebo medications | no estimate extracted | 2 studies · 128 participants | Low Downgraded: imprecision, inconsistency |
Analgesic Success Dexmedetomidine vs control or placebo medications | no estimate extracted | NR | No studies |
Sedation Dexmedetomidine vs control or placebo medications | no estimate extracted | 1 study · 52 participants | Very low Downgraded: imprecision, inconsistency |
Chronic Headache Dexmedetomidine vs control or placebo medications | no estimate extracted | NR | No studies |
Length of hospital stay (hours) Dexmedetomidine vs control or placebo medications | no estimate extracted | NR | No studies |
Adverse event nausea and vomiting (0 to 24 hours) Dexmedetomidine vs control or placebo medications | no estimate extracted | 3 studies · 261 participants | Low Downgraded: imprecision, inconsistency |
Adverse event hypotension (0 to 24 hours) Dexmedetomidine vs control or placebo medications | no estimate extracted | 3 studies · 184 participants | Low Downgraded: imprecision, inconsistency |
Pregabalin or Gabapentin compared with control or placebo medications for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative Pain 0 to 6 hours Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 2 studies · 202 participants | Low Downgraded: imprecision, indirectness |
Acute postoperative pain at 12 hours Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 1 study · 100 participants | Very low Downgraded: imprecision, indirectness |
Acute postoperative pain at 24 hours Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 2 studies · 202 participants | Low Downgraded: imprecision, indirectness |
Acute postoperative pain at 48 hours Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 2 studies · 202 participants | Low Downgraded: imprecision, indirectness |
Additional analgesia requirements at 0 to 24 hours Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 3 studies · 234 participants | Low Downgraded: imprecision, indirectness |
Analgesic Success Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | NR | No studies |
Sedation Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | NR | No studies |
Chronic Headache Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 54 participants | Very low Downgraded: imprecision, indirectness |
Length of critical care stay (hours) Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | NR | No studies |
Length of hospital stay (hours) Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 1 study · 100 participants | Very low Downgraded: imprecision, indirectness |
Adverse event nausea and vomiting (0 to 24 hours) Pregabalin or Gabapentin vs control or placebo medications | no estimate extracted | 3 studies · 273 participants | Low Downgraded: imprecision, indirectness |
Acetaminophen compared with control or placebo medications for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative pain 0 to 6 hours Acetaminophen vs control or placebo medications | no estimate extracted | 3 studies · 332 participants | Moderate Downgraded: imprecision |
Acute postoperative pain at 12 hours Acetaminophen vs control or placebo medications | no estimate extracted | 3 studies · 332 participants | Moderate Downgraded: imprecision |
Acute postoperative pain at 24 hours Acetaminophen vs control or placebo medications | no estimate extracted | 4 studies · 459 participants | High |
Acute postoperative pain at 48 hours Acetaminophen vs control or placebo medications | no estimate extracted | 1 study · 202 participants | Very low Downgraded: imprecision |
Additional analgesia requirements 0 to 24 hours (milligrams) Acetaminophen vs control or placebo medications | no estimate extracted | 4 studies · 459 participants | High |
Analgesic Success Acetaminophen vs control or placebo medications | no estimate extracted | NR | No studies |
Sedation score at 24 hours (Richmond Agitation Sedation scale) Acetaminophen vs control or placebo medications | no estimate extracted | 1 study · 131 participants | Very low Downgraded: imprecision |
Chronic headache Acetaminophen vs control or placebo medications | no estimate extracted | NR | No studies |
Length of critical care stay (hours) Acetaminophen vs control or placebo medications | no estimate extracted | 1 study · 131 participants | Very low Downgraded: imprecision |
Length of hospital stay (hours) Acetaminophen vs control or placebo medications | no estimate extracted | 2 studies · 335 participants | Moderate Downgraded: imprecision |
Adverse events Acetaminophen vs control or placebo medications | no estimate extracted | NR | No studies |
Scalp infiltration compared with control or placebo intervention for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative pain 0 to 6 hours (Score 0 to 10, VAS or NRS Scale) Scalp infiltration vs control or placebo intervention | no estimate extracted | 9 studies · 475 participants | Moderate Downgraded: imprecision, inconsistency |
Acute postoperative pain at 12 hours (Score 0 to 10, VAS or NRS Scale) Scalp infiltration vs control or placebo intervention | no estimate extracted | 7 studies · 309 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 24 hours (Score 0 to 10, VAS or NRS Scale) Scalp infiltration vs control or placebo intervention | no estimate extracted | 6 studies · 260 participants | Moderate Downgraded: imprecision, inconsistency |
Acute postoperative pain at 48 hours (score 0 to 10, VAS or NRS scale) Scalp infiltration vs control or placebo intervention | no estimate extracted | 3 studies · 128 participants | Moderate Downgraded: imprecision, inconsistency |
Additional analgesia requirements 0 to 24 hours (milligrams) Scalp infiltration vs control or placebo intervention | no estimate extracted | 6 studies · 345 participants | Very low Downgraded: imprecision, inconsistency |
Analgesic Success Scalp infiltration vs control or placebo intervention | no estimate extracted | 1 study · 49 participants | Very low Downgraded: imprecision, inconsistency |
Sedation Scalp infiltration vs control or placebo intervention | no estimate extracted | NR | No studies |
Chronic headache Scalp infiltration vs control or placebo intervention | no estimate extracted | NR | No studies |
Length of critical care stay (hours) Scalp infiltration vs control or placebo intervention | no estimate extracted | NR | No studies |
Length of hospital stay (hours) Scalp infiltration vs control or placebo intervention | no estimate extracted | NR | No studies |
Adverse event nausea and vomiting (0 to 24 hours) Scalp infiltration vs control or placebo intervention | no estimate extracted | 4 studies · 318 participants | Low Downgraded: imprecision, inconsistency |
Scalp block compared with control or placebo intervention for prevention of pain in adults undergoing brain surgery
Population: adults undergoing brain surgery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acute postoperative pain 0 to 6 hours (Score 0 to 10, VAS or NRS Scale) Scalp block vs control or placebo intervention | no estimate extracted | 10 studies · 414 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 12 hours (Score 0 to 10, VAS or NRS Scale) Scalp block vs control or placebo intervention | no estimate extracted | 8 studies · 294 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 24 hours (Score 0 to 10, VAS or NRS Scale) Scalp block vs control or placebo intervention | no estimate extracted | 9 studies · 433 participants | Low Downgraded: imprecision, inconsistency |
Acute postoperative pain at 48 hours (Score 0 to 10, VAS or NRS Scale) Scalp block vs control or placebo intervention | no estimate extracted | 4 studies · 135 participants | Very low Downgraded: imprecision, inconsistency |
Additional analgesia requirements 0 to 24 hours Scalp block vs control or placebo intervention | no estimate extracted | 7 studies · 314 participants | Low Downgraded: imprecision, inconsistency |
Analgesic success Scalp block vs control or placebo intervention | no estimate extracted | 1 study · 40 participants | Very low Downgraded: imprecision, inconsistency |
Sedation Scalp block vs control or placebo intervention | no estimate extracted | NR | No studies |
Chronic headache Scalp block vs control or placebo intervention | no estimate extracted | NR | No studies |
Length of critical care stay (hours) Scalp block vs control or placebo intervention | no estimate extracted | NR | No studies |
Length of hospital stay (hours) Scalp block vs control or placebo intervention | no estimate extracted | NR | No studies |
Adverse event nausea and vomiting (0 to 24 hours) Scalp block vs control or placebo intervention | no estimate extracted | 4 studies · 165 participants | Very low Downgraded: imprecision, inconsistency |