Author (Year)

Study Type

Location

Sample size/ Mean age, years

Surgical Procedure

Intraoperative Analgesia

Postoperative Analgesia

Pain Assessment

Follow-Up

Primary Outcome

Secondary outcomes

Risk of Bias

Xing, et al. [4]

RCT

China

160/NS

Open craniotomy

Sufentanyl/ fentanyl IV Reminfentanil TCI

Ropivacaine local infiltration

Fentanyl PCIA/NCIA Morphine PCIA/NCIA

Tramadol PCIA/NCIA

Ibuprofen PO

1, 2, 4, 16, 24, 36, 48 hours post-op

48 hours post-op

FLACC, WBFS, NRS

Change in consciousness, nausea, vomiting, pruritus, respiratory depression, additional acetaminophen

Low

Maxwell, et al. [21]

Prospective cohort

USA

200/7.8 ± 5.8

Craniotomy, craniectomy, craniofacial surgery

Not specified

Morphine/ Fentanyl/ Hydromorphone PCA, Morphine/ Fentanyl/ Hydromorphone as needed IV

Not standardized

5 days post- op

FLACC/ WBFS/ FPS-r

Sedation, vomiting, pruritus, nausea, respiratory depression

Good

Bronco, et al. [25]

Prospective cohort

Italy

212/3.1

Supratentorial or infratentorial craniotomy, cranioplastic surgery

Remifentanil TCI Scalp block

Paracetamol IV

Paracetamol per rectum Rectal codeine Tramadol IV

Between 4-6 hrs post- op then every 8 hrs for 48 hours

48 hours post-op

VAS

Emergence delirium, Sedation, Respiratory depression, Nausea/vomiting

Good

Teo, et al. [26]

Prospective cohort

Australia

52/7.2

Emergency or elective craniotomy

Remifentanil TCI Morphine IV Scalp block

Paracetamol IV Codeine IV Morphine PCA/IV

Twice daily

72 hours post-op

FLACC, WBFS, NRS

Not measured

Good

Lim, et al. [27]

Retrospective cohort

Korea

97/8.5 ± 3.4

Encephaloduroa rteriosynangiosis (Moyamoya surgery)

Propofol TCI Remifentanil/ Sufentanil TCI Scalp block

Fentanyl PCA, Sufentanil PCA

0.5, 1, 2, 4, 12, 24, 48 hours post-op

48 hours post-op

NRS, FPS-r, additional analgesic administration

Nausea/vomiting, headache, pruritus, drowsiness

Good

Warre, et al. [28]

Retrospective cohort

Canada

71/4.8

Cranial reconstruction, craniotomy

Not specified

Morphine IV Acetaminophen or codeine as needed

Every 4 hours

72 hours post-op

FLACC, WBFS, VAS

Nausea/vomiting, respiratory depression, excess sedation

Good

Gohari, et al. [29]

RCT

Egypt

30/8.9 ± 2.1

Craniotomy for supratentorial excision of tumor

Fentanyl IV, Sevoflurane, Scalp block

Paracetamol per rectum

1, 2, 4, 8, 12 hours post-op

24 hours post-op

VAS

Local anesthetic side effects

Low

Chiaretti, et al. [30]

RCT

Italy

42/5.6 ± 4.5

Neurosurgery for tumor, decompression, and Chiari malformation

Tramadol, Fentanyl, Halothane

None

Every 4 hours

36 hours post-op

AFS, CHEOPS

Nausea, vomiting, apnea, bradycardia

Unclear

Smyth, et al. [31]

Prospective cohort

USA

50/11.4

Suboccipital intracranial decompression

Not specified

Acetaminophen PO, ibuprofen PO

Every 8 hours

Notstandardized

WBFS, additional narcotics required

Nausea, pruritus, urinary retention

Good