Prospective assessment of postoperative pain after craniotomy.

Abstract

UNLABELLED:

Pain after craniotomy may be underdiagnosed, despite the fact that it can increase postoperative complications for example arterial hypertension and postoperative hemorrhage. This study investigates the incidence and intensity of pain after craniotomy and characterizes the influencing parameters. During a 1-year period 256 patients undergoing elective craniotomy were prospectively included in the study. Intensity of pain was evaluated 1, 4, and 24 hours after extubation using a verbal numerical rating scale (NRS) ranging from 0 (no pain) to 10 (maximal pain). Routine perioperative pain management was not influenced by the investigators. Parameters including patient-related factors, drug administration, and surgical factors were correlated with incidence and intensity of postcraniotomy pain.

STATISTICAL ANALYSIS:

logistic regression and chi using SPSS program (Windows, version 12.0). During the first 24 hours 87% of the patients experienced pain (NRS 1 to 3: 32%, NRS 4 to 7: 44%, NRS 8 to 10: 11%). For postoperative analgesia, the opioid piritramide (a mu-receptor agonist) was administered to 70% and nonopiod analgesics to 73% of the patients. The probability of experiencing postcraniotomy pain was reduced by 3% for each year of life. Maintenance of anesthesia with sevoflurane increased the probability of suffering from postcraniotomy pain by 147% and the absence of corticosteroids by 119%. Other investigated parameters did not influence pain after craniotomy. This study shows that pain is experienced by the majority of patients after craniotomy, despite conventional pain management, emphasizing the necessity for improved and individualized pain management in this special group of patients.

• Authors: Christine Mordhorst, Björn Latz, Thomas Kerz, Gregor Wisser, Annette Schmidt, Astrid Schneider, Annette Jahn-Eimermacher, Christian Werner, Kristin Engelhard
• Journal: Journal of neurosurgical anesthesiology (J Neurosurg Anesthesiol) Vol. 22 Issue 3 Pg. 202-6 (Jul 2010) ISSN: 1537-1921 [Electronic] United States
• PMID: 20479664 (Publication Type: Journal Article)

Chemical References

• Analgesics, Opioid
• Anesthetics, Inhalation
• Methyl Ethers
• Sevoflurane
• Pirinitramide

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Aging (physiology)
• Analgesics, Opioid (therapeutic use)
• Anesthesia, General
• Anesthesia, Inhalation
• Anesthesia, Intravenous
• Anesthetics, Inhalation
• Brain (surgery)
• Craniotomy
• Critical Care
• Female
• Humans
• Logistic Models
• Male
• Methyl Ethers
• Middle Aged
• Neurosurgical Procedures
• Pain Measurement
• Pain, Postoperative (diagnosis, drug therapy)
• Pirinitramide (therapeutic use)
• Prospective Studies
• Sevoflurane
• Young Adult