Exploring the Effectiveness of New Modalities in Pain Management for Postoperative Neurosurgery Patients

Dr. Sheikh Khurshid Alam Ali, Dr. Kalyan Sarma

Abstract: Introduction: Postoperative pain management in neurosurgery patients is complex due to severe pain from cranial and spinal procedures and the need to preserve neurological assessment. This study evaluates new modalities-multimodal analgesia (MMA) with ketamine infusions and scalp nerve blocks (SNBs)-against traditional opioid-based regimens. Methods: Fifty postoperative neurosurgery patients were randomized into two groups: MMA (ketamine 0.1-0.2 mg/kg/h for 48 hours, SNBs with bupivacaine 0.25%, plus as-needed opioids) or control (morphine PCA). Pain (VAS), opioid use, sedation (RASS), and neurological status (GCS) were assessed over 72 hours, analyzed with t-tests and chi-square tests (p<0.05). Results: MMA reduced VAS scores by 40% (2.1 vs.3.5, p<0.01) and opioid use by 50% (15.4 mg vs.31.2 mg, p<0.001) at 72 hours compared to controls, with no differences in sedation or GCS. Discussion: MMA with ketamine and SNBs significantly improved pain control and reduced opioid reliance, maintaining neurological monitoring integrity. Mild hallucinations in 12% of MMA patients suggest dosing adjustments may be needed. Conclusion: New modalities like MMA enhance postoperative pain management in neurosurgery, offering a promising opioid-sparing approach, warranting further study.

Keywords: Postoperative pain, neurosurgery, multimodal analgesia, ketamine, scalp nerve blocks, opioid-sparing