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Updated: Jun 3, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Post-craniotomy pain in a paediatric population
J H Teo1, G M Palmer, A J Davidson
1Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Children undergoing neurosurgery experience minimal pain, with most receiving multimodal analgesia including parenteral morphine. Older age was linked to higher pain scores, but significant respiratory depression was not observed.
Area of Science:
- Pediatric Anesthesiology
- Neurosurgery
- Pain Management
Background:
- Limited data exists on pediatric pain and analgesia post-neurosurgery.
- Understanding pain experiences is crucial for optimizing care.
Purpose of the Study:
- Assess pain levels in children after craniotomy.
- Evaluate analgesic regimens used.
- Identify factors associated with significant pain.
Main Methods:
- Retrospective data collection from 52 children over 72 hours post-craniotomy.
- Pain assessed by nursing staff and an independent auditor.
- Multivariate regression analysis used.
Main Results:
- Median pain scores were low (0.7 by nurses, 1.3 by auditor).
- 42% of children experienced at least one pain score >= 3.
- Older age correlated with higher pain scores; procedure duration with prolonged morphine use.
Conclusions:
- Multimodal analgesia, including parenteral morphine, is common post-neurosurgery.
- This approach is generally associated with low pain scores in children.
- Older age is a factor for increased pain episodes.
Abstract:
There is little information about analgesia use or pain experienced in children after neurosurgery. The aims of this study were to assess the degree of pain experienced by children after neurosurgery and the analgesic regimens used, and to identify factors associated with significant pain. Data for 52 children who underwent craniotomy were collected contemporaneously over 72 hours. Data included demographics, intraoperative surgical and anaesthetic details, postoperative medications and postoperative pain scores as routinely collected by nursing staff Pain was also assessed by an independent observer (auditor) using an age and developmentally appropriate tool, on a scale from zero to 10. For most of the time the children had little or no pain. Over the 72 hours the median pain score recorded by nursing staff was 0.7 and by the auditor was 1.3. However in spite of the low median scores, 42% of children had at least one episode of a pain score > or = 3. Postoperatively, 71% of children received parenteral morphine, 92% of children received paracetamol, 35% oxycodone, 19% oral codeine, 4% tramadol and 2% ibuprofen. Using multivariate regression, duration of procedure was the only factor associated with parenteral morphine use for > 24 hours, and older age was the only factor associated with having an episode of pain scoring > 3. No episodes of significant respiratory depression were noted. At our institution, children receive multimodal analgesia after neurosurgery, commonly parenteral morphine, and this is usually associated with low pain scores.
