Assessment and management of perioperative pain in neurosurgical patients

This PhD thesis investigated the assessment and management of pain in a neurosurgical population. A national survey of anesthesiologists in India was conducted to understand practices for pain assessment and management in patients undergoing neurosurgeries. The practices varied, with 50% using structured format for pain assessment/management, and 15% using opioids for postoperative pain relief. To understand the burden of pain after brain surgery in India, a prospective observational study was performed. Two out of three patients reported significant pain during the first three days of surgery. Reporting of pain is not possible under anesthesia. Hence, objective methods are explored. During tracheal intubation, changes in analgesia nociception index, a monitor for intraoperative pain/nociception, were found to correlate with changes in heart rate and blood pressure. Another parameter, the surgical pleth index, also predicted pain and response to analgesics during brain surgery. Non-opioid pain medicines were found to be equivalent to opioids in brain surgery, and superior in spine surgery, in clinical trials and the meta-analysis performed as part of this thesis.