Effect of Sumatriptan on the Postoperative Quality of Recovery After Elective Minimally Invasive Craniotomy
Status:
Completed
Trial end date:
2019-12-15
Target enrollment:
Participant gender:
Summary
Postoperative migrainous headache following craniotomy is distressing and may cause
significant morbidity and often delay discharge from the hospital. The mechanism of this post
craniotomy migraine is multifactorial. Possible causes include the intraoperative loss of
cerebrospinal fluid leading to stretching of the dura, traction on intracranial vessels and
meningeal irritation. There are two groups of patients who undergo elective minimally
invasive craniotomies and yet have considerable postoperative migraine headache
postoperatively. These are patients who have a craniotomy for clipping of an unruptured
cerebral aneurysm and patients who require a microvascular decompressive craniotomy for
cranial nerve pain such as trigeminal neuralgia. Their postoperative migrainous headache
often impairs the quality of their recovery and may even delay discharge from hospital.
Opioid analgesics are not always effective and may also worsen the postoperative nausea and
vomiting and in turn postoperative quality of their recovery. Sumatriptan is a drug that has
been used for decades for the treatment of migraine headaches. It acts on 5hydroxytryptophan
receptors, which are located in the dura mater (lining of the brain) and are also located
around the cranial trigeminal nerve ganglion. Thus sumatriptan may be an effective to improve
postoperative migraine , nausea and vomiting and overall quality of recovery. We plan to do a
randomized double blind placebo controlled trial on the effect of Sumatriptan for
postoperative migraine on the postoperative quality of recovery after elective minimally
invasive craniotomies. A total of 92 patients scheduled to undergo minimally invasive
craniotomy for either clipping of an unruptured aneurysm or microvascular decompression for
cranial nerve neuralgias will be included in this study. Patients within the 2 surgical
groups with postoperative migraine will then be block randomized to receive either 6mg of
sumatriptan subcutaneously or placebo following assessment in the post operative care unit
(PACU). The primary outcome measure will be quality of recovery at 24 hours using Quality of
recovery 40 Questionnaire (QoR-40). Our secondary outcome will be postoperative pain,
analgesic consumption, side effects and hospital discharge times.