• Toshitsugu Terakado, Yasunobu Nakai, Go Ikeda, Kazuya Uemura, Yuji Matsumaru, Eiichi Ishikawa, and Akira Matsumura.
• Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan. Electronic address: toshi_0211jp@yahoo.co.jp.
• World Neurosurg. 2020 Feb 1; 134: e339-e345.

BackgroundAfter subarachnoid hemorrhage (SAH), headache management is often difficult owing to the need to use multiple analgesic drugs. Fentanyl is an opioid we can use after surgery, and it can decrease pain post SAH. The aim of this study was to investigate the effectiveness and safety of fentanyl for management of headache after SAH.MethodsTwenty-two patients who underwent surgical clipping for ruptured intracranial aneurysms and complained of severe headache after the surgery were enrolled. Among them, 9 patients were given fentanyl combined with other analgesic drugs. The numeric rating scale score and dietary intake were measured in the acute phase after the SAH.ResultsThe numeric rating scale scores were significantly lower in the fentanyl (+) group. The maximum numeric rating scale decreased to <5 points within 16.5 ± 2.9 days in the fentanyl (-) group and within 12.0 ± 2.6 days in the fentanyl (+) group. The median numeric rating scale decreased to <5 points over 14.0 ± 4.2 days in the fentanyl (-) group and >7.7 ± 3.8 days in the fentanyl (+) group. At day 14, the fentanyl (+) group showed significantly better dietary intake than that of the fentanyl (-) group.ConclusionsUsing fentanyl after surgical clipping for ruptured intracranial aneurysms might decrease headache and produce few adverse effects. Adequate headache control showed improved dietary intake after SAH.Copyright © 2019 Elsevier Inc. All rights reserved.

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