Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effect of Sumatriptan on the Postoperative Quality of Recovery After Elective Minimally Invasive Craniotomy
Brief 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.


Options:
A: Inclusion Criteria:

* \> 45 kg (amenable to adult dosing)
* all traumatic brain injuries NPO for at least 12 hours
* all post-operative craniotomy patients
* all non-operative subarachnoid hemorrhage, intraparenchymal hemorrhage, and stroke patients
* all carotid endarterectomy and carotid artery stenosis patients
* all endovascular patients undergoing intracranial intervention
* all post-op spine patients admitted to the NCCU

Exclusion Criteria:

* documented allergy to acetaminophen
* documented severe hepatic impairment (Child-Pugh score \> 6) or severe hepatic disease (hepatitis)
* documented severe renal impairment (CrCl \< 30 ml/min) Blood tests will be performed prior to study procedures that will ensure patients do not have renal impairment.
* patients who are pregnant or breast feeding
B: Inclusion Criteria:

* Adult patient undergoing ENTS surgery for resection of pituitary tumor.
* Adults \>18 years and \<80 years of age.
* English speaking and literate or able to understand the use of a pain scale.
* Body Mass Index \>19 and \<40 kg/m2

Exclusion Criteria:

* Renal failure (acute or chronic) or creatinine \>2.0
* Allergy or intolerance to acetaminophen, ibuprofen, or opioids
* Pre-operative opioid tolerance, dependence, or abuse
* Anaphylaxis to opioids
* History of peptic ulcer disease or recent gastrointestinal bleed requiring surgery
* Cirrhosis, hepatitis, liver transplant, or liver function studies out of normal range, defined as aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/bilirubin\> 3x upper limit of normal range
* Subject unwilling or unable to sign informed consent for the study
* Pregnancy
* Incarcerated patients
C: Inclusion Criteria:

* Supratentorial craniotomy, glasgow coma scale 15

Exclusion Criteria:

* Chronic pain,
* Chronic opioid use.
* History of significant alcohol or benzodiazepine (BZD) use,
* Inability to speak English,
* Pre-operative aphasia or dysphasia,
* Renal impairment (Creatinine level \> 0.1),
* Asthma (or evidence of reversible airway obstruction,
* Known ischaemic heart disease or cerebrovascular disease,
* American Society of Anaesthesiologists (ASA) grade IV or V,
* Allergy to any study drug (paracetamol, parecoxib, sulphas, morphine, bupivacaine, propofol, remifentanil;
* Administration of oral paracetamol within previous 8 hours.
* Pregnancy or breastfeeding
D: Inclusion Criteria:

1. Patients having elective craniotomy for clipping of unruptured intracranial aneurysm
2. Patients having craniotomy and microvascular decompression for cranial nerve neuralgia
3. Age 18-80
4. ASA I -III

Exclusion Criteria:

1. Patients with a known history of hypersensitivity to Sumatriptan or sulphonamides
2. Patients with a known history of Migraine
3. Patients who is on regular treatment with Sumatriptan
4. Patients with history of Ischemic heart disease - Angina, Myocardial infarction.
5. Patients who had rupture of their intracranial aneurysm.
6. Patients with history of severe liver disease.
7. Patients with history of stroke or uncontrolled hypertension
8. Inability to give informed consent
9. Pregnant patient

Answer: D