Perspectives on Analgesia for Craniotomy: A Survey of Anesthetic Practices

Background: This study aimed to compare analgesic practices for patients undergoing craniotomy in high-income countries (HICs) and low-income and middle-income countries (LMICs), focusing on variations in medication use and techniques. Methods: An English-language and Spanish-language electronic survey was sent to over 300 anesthesiologists in 35 countries from March 22 to May 19, 2024, to gather data on analgesia for craniotomy patients. Anonymous responses through REDCap were analyzed as a whole and by income category (HICs and LMICs). Results: We received 328 responses (105 HICs, 221 LMICs, and 2 missing locations). Acetaminophen was used by 78% of respondents (HIC: 82%, LMIC: 76%), with low nonavailability in both groups (0.95% HICs, 4.98% LMICs). Fentanyl boluses were used in 57% of cases (HIC: 60%, LMIC: 55%). Incisional local anesthesia was administered in 51% (HIC: 52%, LMIC: 50%), with minimal nonavailability (1.9% HIC, 1.4% LMIC). The use of a remifentanil infusion was more common in HICs (64%) than LMICs (31%), where nonavailability was significantly higher (43.89% vs. 7.62% HICs). Scalp blocks were used by 15% of HICs and 43% of LMICs. Craniotomy indication influenced the choice of analgesia for 61% of respondents. Conclusions: Analgesic practices for craniotomy vary significantly between HICs and LMICs, primarily due to medication availability. Global guidelines should consider resource differences to improve postoperative pain management.