{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T05:34:51Z","timestamp":1775626491694,"version":"3.50.1"},"reference-count":12,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Poor pain control has a negative impact on postoperative recovery and patient satisfaction. However, overzealous pain management, particularly with opioids, can confound serial neurological assessments, increase morbidity, and predispose patients to long-term dependence. Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in treating postoperative pain and can limit opioid intake, but their use has been limited in patients undergoing craniotomy for brain tumor resection due to concerns of an increased hemorrhage risk. Herein, the authors aim to 1) address the safety of NSAID use in the immediate postoperative setting and 2) determine whether NSAID administration decreases opioid use following craniotomy for tumor resection in adult patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective cohort study of patients 18 years and older with an estimated glomerular filtration rate \u2265 60 ml\/min\/body surface area who had undergone craniotomy for tumor resection at their institution between 2019 and 2021. NSAID use in the first 48 hours following surgery was recorded. Primary outcomes were postoperative hemorrhage requiring a return to the operating room before hospital discharge and within 30 days of surgery. Secondary outcomes were more-than-minimal hemorrhage that did not require reoperation, acute kidney injury, and total opioid use within 48 hours after craniotomy.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Among 1765 reviewed patient records, 1182 were eligible for inclusion in this analysis. Amid these records were 114 patients (9.6%) who had received at least one dose of an NSAID within 48 hours of their craniotomy. Four (0.3%) patients experienced bleeding requiring a return to operating room, one of whom was from the NSAID-treated group (RR 3.12, 95% CI 0.33\u201329.77, p = 0.30). No significant difference in nonoperative intracranial hemorrhage (RR 1.34, 95% CI 0.54\u20133.35, p = 0.53), postoperative acute kidney injury, or clinically significant extracranial bleeding was found between the NSAID and no-NSAID groups. Patients in the NSAID group had significantly higher oral morphine equivalent use (median 68 vs 30, p &lt; 0.001).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Postoperative NSAID use following craniotomy for tumor resection was not associated with an increased risk of hemorrhage requiring a return to the operating room. The authors noted higher opioid use in the patients treated with NSAIDs, which may reflect underlying reasons for the decision to treat patients with NSAIDs in the immediate postoperative period. These data warrant further investigation of NSAIDs as a safe, opioid-sparing postoperative pain management strategy in patients with normal kidney function who are undergoing intracranial tumor resection.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.11.jns231600","type":"journal-article","created":{"date-parts":[[2024,2,3]],"date-time":"2024-02-03T01:47:12Z","timestamp":1706924832000},"page":"117-122","source":"Crossref","is-referenced-by-count":7,"title":["Safety of the immediate use of nonsteroidal anti-inflammatory drugs after adult craniotomy for tumor"],"prefix":"10.3171","volume":"141","author":[{"given":"Jennifer L.","family":"Perez","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan M.","family":"Naylor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan M. J.","family":"Bauman","sequence":"additional","affiliation":[{"name":"Alix School of Medicine, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel Jeremiah","family":"Harrison","sequence":"additional","affiliation":[{"name":"Alix School of Medicine, Mayo Clinic, Rochester, Minnesota; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyelin","family":"Knowles","sequence":"additional","affiliation":[{"name":"Morehouse School of Medicine, Atlanta, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Terry C.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Link","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Peris Celda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredric B.","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamie","family":"Van Gompel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Parney","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Nurs Crit Care","first-page":"277","article-title":"A review of the efficacy and safety of opioid analgesics post-craniotomy","volume":"9","author":"Roberts G","year":"2004","unstructured":"Roberts G. A review of the efficacy and safety of opioid analgesics post-craniotomy. Nurs Crit Care. 2004;9(6):277\u2013283."},{"issue":"5","key":"b2","series-title":"Anesthesiology","first-page":"891","article-title":"Association of multimodal pain management strategies with perioperative outcomes and resource utilization: a population-based study","volume":"128","author":"Memtsoudis SG","year":"2018","unstructured":"Memtsoudis SG, Poeran J, Zubizarreta N,  Association of multimodal pain management strategies with perioperative outcomes and resource utilization: a population-based study. Anesthesiology. 2018;128(5):891\u2013902."},{"issue":"6 (Pt 2)","key":"b3","series-title":"Pharmacotherapy","first-page":"71S","article-title":"Effects of ketorolac tromethamine on hemostasis","volume":"10","author":"Greer IA","year":"1990","unstructured":"Greer IA. Effects of ketorolac tromethamine on hemostasis. Pharmacotherapy. 1990;10(6 (Pt 2)):71S\u201376S."},{"key":"b4","first-page":"531","article-title":"Risk of reoperation for hemorrhage in patients after craniotomy","volume":"87","author":"Algattas H","year":"2016","unstructured":"Algattas H, Kimmell KT, Vates GE. Risk of reoperation for hemorrhage in patients after craniotomy. World Neurosurg. 2016;87:531\u2013539."},{"key":"b5","series-title":"Hematology (Am Soc Hematol Educ Program)","first-page":"403","article-title":"Acquired disorders of platelet function","volume":"1","author":"Hassan AA","year":"2005","unstructured":"Hassan AA, Kroll MH. Acquired disorders of platelet function. Hematology (Am Soc Hematol Educ Program). 2005;1:403\u2013408."},{"issue":"3","key":"b6","series-title":"J Neurosurg Pediatr","first-page":"327","article-title":"Safety of immediate use of nonsteroidal antiinflammatory drugs after pediatric craniotomy for tumor","volume":"26","author":"Nesvick CL","year":"2020","unstructured":"Nesvick CL, Oushy S, Daniels DJ, Ahn ES. Safety of immediate use of nonsteroidal antiinflammatory drugs after pediatric craniotomy for tumor. J Neurosurg Pediatr. 2020;26(3):327\u2013333."},{"issue":"2","key":"b7","series-title":"Anesth Analg","first-page":"443","article-title":"Intracranial hemorrhage requiring surgery in neurosurgical patients given ketorolac: a case-control study within a cohort (2001\u20132010)","volume":"116","author":"Magni G","year":"2013","unstructured":"Magni G, La Rosa I, Melillo G, Abeni D, Hernandez H, Rosa G. Intracranial hemorrhage requiring surgery in neurosurgical patients given ketorolac: a case-control study within a cohort (2001\u20132010). Anesth Analg. 2013;116(2):443\u2013447."},{"issue":"1","key":"b8","series-title":"J Neurosurg Anesthesiol","first-page":"32","article-title":"Evaluating the role of flupirtine for postcraniotomy pain and compare it with diclofenac sodium: a prospective, randomized, double blind, placebo-controlled study","volume":"26","author":"Yadav G","year":"2014","unstructured":"Yadav G, Choupoo S, Das SK,  Evaluating the role of flupirtine for postcraniotomy pain and compare it with diclofenac sodium: a prospective, randomized, double blind, placebo-controlled study. J Neurosurg Anesthesiol. 2014;26(1):32\u201336."},{"issue":"1","key":"b9","series-title":"J Neurosurg Pediatr","first-page":"107","article-title":"Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients","volume":"17","author":"Richardson MD","year":"2016","unstructured":"Richardson MD, Palmeri NO, Williams SA,  Routine perioperative ketorolac administration is not associated with hemorrhage in pediatric neurosurgery patients. J Neurosurg Pediatr. 2016;17(1):107\u2013115."},{"issue":"3","key":"b10","series-title":"Pain Rep","first-page":"e948","article-title":"Safety and efficacy of an opioid-sparing analgesic protocol in pain control after cranial","volume":"6","author":"Ahmad S","year":"2021","unstructured":"Ahmad S, Khanna R, Onyewuenyi AC, Panos N, Breslin R, Sani S. Safety and efficacy of an opioid-sparing analgesic protocol in pain control after cranial. Pain Rep. 2021;6(3):e948."},{"issue":"3","key":"b11","series-title":"J Neurosurg Anesthesiol","first-page":"321","article-title":"Diclofenac is superior to paracetamol in postoperative pain scores and analgesic consumption in supratentorial craniotomy with no difference in platelet and clot function: a prospective randomized controlled trial","volume":"34","author":"Rajkiran R","year":"2022","unstructured":"Rajkiran R, Soni SL, Jangra K,  Diclofenac is superior to paracetamol in postoperative pain scores and analgesic consumption in supratentorial craniotomy with no difference in platelet and clot function: a prospective randomized controlled trial. J Neurosurg Anesthesiol. 2022;34(3):321\u2013326."},{"issue":"12","key":"b12","series-title":"J Thromb Haemost","first-page":"2376","article-title":"Effects of selective COX-2 inhibition on prostanoids and platelet physiology in young healthy volunteers","volume":"5","author":"Graff J","year":"2007","unstructured":"Graff J, Skarke C, Klinkhardt U,  Effects of selective COX-2 inhibition on prostanoids and platelet physiology in young healthy volunteers. J Thromb Haemost. 2007;5(12):2376\u20132385."}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/1\/article-p117.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/1\/article-p117.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/141\/1\/article-p117.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,26]],"date-time":"2024-11-26T11:47:15Z","timestamp":1732621635000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/141\/1\/article-p117.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,1]]},"references-count":12,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2023.11.jns231600","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,1]]}}}