Pain following craniotomy is common, however, achieving effective analgesia can be difficult. The assessment of pain postoperatively can be a challenge in patients who are obtunded (not fully alert) and the severity of pain has historically been underestimated. There are also concerns about side-effects from drugs, particularly with opioids, which may lead to reluctance to administer effective doses. A multimodal technique, using different agents, is most likely to be effective. This article discusses these issues and highlights the role of the nurse in optimising patient comfort and healing after surgery.

Michael Puntis - Specialty Registar in Anaesthesia and Intensive Care Medicine, St George's School of Anaesthesia

Anne Garner - Consultant in Neuro-anaesthesia and Neuro-Intensive Care, St George's Healthcare NHS Foundation Trust, London