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Incidence of pain after craniotomy in children
Alfio Bronco1, Domenico Pietrini, Massimo Lamperti
1Department of Anesthesia and Intensive Care I, Ospedale San Gerardo di Monza, Monza, Italy; Deparment of Experimental Medicine, University of Milano-Bicocca, Monza, Italy.
Insights
Children undergoing major craniotomy experience minimal postoperative pain with multimodal analgesia. Longer surgical procedures increase the risk of moderate to severe pain in pediatric patients.
Area of Science:
- Pediatric Surgery
- Pain Management
- Neuroscience
Background:
- Limited data exists on pediatric pain following craniotomy.
- Craniotomy is a significant surgical procedure in children.
Purpose of the Study:
- To assess the incidence of postoperative pain in children after major craniotomy.
- To identify factors associated with pain intensity and analgesic use.
Main Methods:
- Multicenter observational study involving 206 children under 10 years old undergoing craniotomy.
- Pain intensity was measured using FLACC (Face, Legs, Activity, Cry, Consolability) or NRS (Numerical Rating Scale) scores.
- Analgesic therapy and adverse effects were recorded for the first two days post-surgery.
Main Results:
- The overall postoperative pain scores were low (median FLACC/NRS: 1).
- 16% of children experienced moderate to severe pain in the recovery room, decreasing to 6% by days 1-2.
- Longer surgical procedures were associated with an increased risk of moderate to severe pain (OR 1.30) and severe pain (OR 1.41).
Conclusions:
- Multimodal analgesia effectively manages pain in children after major craniotomy, resulting in little to no pain.
- Extended surgical duration is a risk factor for postoperative pain in this pediatric population.
Background:
There is very few information regarding pain after craniotomy in children.
Objectives:
This multicentre observational study assessed the incidence of pain after major craniotomy in children.
Methods:
After IRB approval, 213 infants and children who were <10 years old and undergoing major craniotomy were consecutively enrolled in nine Italian hospitals. Pain intensity, analgesic therapy, and adverse effects were evaluated on the first 2 days after surgery. Moderate to severe pain was defined as a median FLACC or NRS score ≥ 4 points. Severe pain was defined as a median FLACC or NRS score ≥ 7 points.
Results:
Data of 206 children were included in the analysis. The overall postoperative median FLACC/NRS scores were 1 (IQR 0 to 2). Twenty-one children (16%) presented moderate to severe pain in the recovery room and 14 (6%) during the first and second day after surgery. Twenty-six children (19%) had severe pain in the recovery room and 4 (2%) during the first and second day after surgery. Rectal codeine was the most common weak opiod used. Remifentanil and morphine were the strong opioids widely used in PICU and in general wards, respectively. Longer procedures were associated with moderate to severe pain (OR 1.30; CI 1.07-1.57) or severe pain (OR 1.41; 1.09-1.84; P < 0.05). There were no significant associations between complications, pain intensity, and analgesic therapy.
Conclusion:
Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
