Postoperative pain management with tramadol after craniotomy: evaluation and cost analysis

J Neurosurg. 2010 Feb;112(2):268-72. doi: 10.3171/2008.9.17689.


Object: Patients undergoing craniotomies have traditionally received opiates with acetaminophen for the management of their postoperative pain. The use of narcotic pain medications can be costly, decrease rates of early postoperative ambulation, lengthen hospital stays, and alter a patient's neurological examination. The use of alternative pain medications such as tramadol may benefit patients by resolving many of these issues.

Methods: The authors conducted a randomized, blinded prospective study to evaluate the efficacy of alternative pain management strategies for patients following craniotomies. Fifty patients were randomly assigned either to a control group who received narcotics and acetaminophen alone or an experimental group who received tramadol in addition to narcotic pain medications (25 patients assigned to each group).

Results: The control group was noted to have statistically significant higher visual analog scale pain scores, an increased length of hospital stay, and increased narcotic use compared with the tramadol group. The narcotics and acetaminophen group also had increased hospitalization costs when compared with the tramadol group.

Conclusions: The use of scheduled atypical analgesics such as tramadol in addition to narcotics with acetaminophen for the management of postoperative pain after craniotomy may provide better pain control, decrease the side effects associated with narcotic pain medications, encourage earlier postoperative ambulation, and reduce total hospitalization costs.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / administration & dosage
  • Acetaminophen / economics
  • Acetaminophen / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Non-Narcotic / administration & dosage
  • Analgesics, Non-Narcotic / economics
  • Analgesics, Non-Narcotic / therapeutic use
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / economics
  • Analgesics, Opioid / therapeutic use*
  • Craniotomy* / economics
  • Drug Therapy, Combination
  • Female
  • Hospitalization / economics
  • Humans
  • Length of Stay / economics
  • Male
  • Middle Aged
  • Narcotics / administration & dosage
  • Narcotics / economics
  • Narcotics / therapeutic use
  • Pain Measurement
  • Pain, Postoperative / drug therapy*
  • Tramadol / administration & dosage
  • Tramadol / economics
  • Tramadol / therapeutic use*
  • Treatment Outcome
  • Young Adult


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Narcotics
  • Acetaminophen
  • Tramadol