Perspectives on Analgesia for Craniotomy: A Survey of Anesthetic Practices

Anita Vincent, Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC.
Mark A. Burbridge, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA.
Nophanan Chaikittisilpa, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Indranil Chakraborty, University of Arkansas for Medical Sciences, Little Rock, AR.
Michelle Chong, Saint Vincent's Hospital, Monash Medical Centre, Melbourne, VIC, Australia.
Tumul Chowdhury, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
Paul Garcia, Department of Anesthesiology, Columbia University New York, NY.
John G. Gaudet, Lausanne University Hospital, Lausanne, Switzerland.
Taniga Kiatchai, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Hemanshu Prabhakar, All India Institute of Medical Sciences, New Delhi, India.
Ananya A. Shiferaw, Addis Ababa University, Addis Ababa, Ethiopia.
Gentle S. Shrestha, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
Peter C. Tan, Sarawak General Hospital, Sarawak, Malaysia, Malaysia.
Cristiane Tavares, Hospital das Clínicas of the University of Sao Paulo School of Medicine, Sao Paulo, Brazil.
Susana Vacas, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Samuel N. Blacker, Department of Anesthesiology, University of North Carolina Chapel Hill, NC.
Abhijit V. Lele, University of Washington, Harborview Medical Center, Seattle, WA.
Jorge Mejia-Mantilla, Department of Critical Care Medicine, Fundacion Valle del Lili, Cali, Colombia.

Document Type

Journal Article

Publication Date

7-1-2025

Journal

Journal of neurosurgical anesthesiology

Volume

37

Issue

3

DOI

10.1097/ANA.0000000000001033

Keywords

analgesia; craniotomy; global anesthesia practices; neurosurgical anesthesia; survey

Abstract

BACKGROUND: This study aimed to compare analgesic practices for patients undergoing craniotomy in high-income countries (HICs) and low-income and middle-income countries (LMICs), focusing on variations in medication use and techniques. METHODS: An English-language and Spanish-language electronic survey was sent to over 300 anesthesiologists in 35 countries from March 22 to May 19, 2024, to gather data on analgesia for craniotomy patients. Anonymous responses through REDCap were analyzed as a whole and by income category (HICs and LMICs). RESULTS: We received 328 responses (105 HICs, 221 LMICs, and 2 missing locations). Acetaminophen was used by 78% of respondents (HIC: 82%, LMIC: 76%), with low nonavailability in both groups (0.95% HICs, 4.98% LMICs). Fentanyl boluses were used in 57% of cases (HIC: 60%, LMIC: 55%). Incisional local anesthesia was administered in 51% (HIC: 52%, LMIC: 50%), with minimal nonavailability (1.9% HIC, 1.4% LMIC). The use of a remifentanil infusion was more common in HICs (64%) than LMICs (31%), where nonavailability was significantly higher (43.89% vs. 7.62% HICs). Scalp blocks were used by 15% of HICs and 43% of LMICs. Craniotomy indication influenced the choice of analgesia for 61% of respondents. CONCLUSIONS: Analgesic practices for craniotomy vary significantly between HICs and LMICs, primarily due to medication availability. Global guidelines should consider resource differences to improve postoperative pain management.

Department

Anesthesiology and Critical Care Medicine

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