title: Craniotomy procedures are associated with less analgesic requirements than other surgical procedures.
abstract: The conventional wisdom that neurosurgical patients experience minimal postoperative pain and require little analgesia has been challenged. To address this, we reviewed our anesthesia and postanesthesia care unit (PACU) records for 1995 and compared pain management in patients undergoing major intracranial and selected extracranial procedures. We recorded patient weight, operative time, time in the PACU, intraoperative and postoperative opioid use, PACU pain scores, and level of consciousness in patients who had undergone open fixation of mandible or maxilla (Group E), clipping of aneurysms or excision of tumors (Group I), or lumbar laminectomy (Group L). Group I (n = 78) patients received less fentanyl in the operating room (0.016 microg x kg(-1) x min(-1) versus 0.023 microg x kg(-1) x min(-1) for Group E [n = 134] and 0.023 microg x kg(-1) x min(-1) for Group L [n = 21]; P < 0.05), received less morphine in the PACU (0.0004 vs 0.0013 vs 0.0015 mg kg(-1) x min(-1); P < 0.005), reported lower pain scores (0.76 vs 2.5 vs 2.4; P < 0.05), and spent less time in the PACU (89.5 vs 109 vs 105 min; P < 0.05) than Group E or L patients. Our results were similar when only patients with Glasgow Coma Scale scores > or = 14 were used in a subset analysis. We conclude that patients suffer less pain and use fewer opioids in the PACU after intracranial surgery than after facial reconstruction or lumbar laminectomy. Our results confirm that the average craniotomy patient has less postoperative pain than patients who undergo other surgical procedures, although patients who undergo frontal craniotomy may require more aggressive pain management.
  
  
  CONCLUSIONS
  This study compares the pain report and analgesic use in patients after intracranial versus extracranial surgery. The results confirm the commonly held but recently challenged belief that neurosurgery patients suffer less pain postoperatively than other patients. In this study, we found that most patients report minimal pain after intracranial surgery but that a small subset of patients, many of whom have undergone frontal craniotomies, require aggressive treatment of postoperative pain.
authors.affiliation: Department of Anesthesiology, Harborview Medical Center, University of Washington School of Medicine, Seattle 98104-2499, USA. pjdunbar@u.washington.edu
authors.forename: P J
authors.initials: PJ
authors.lastname: Dunbar
authors.forename: E
authors.initials: E
authors.lastname: Visco
authors.forename: A M
authors.initials: AM
authors.lastname: Lam
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001835:Body Weight; D001921:Brain / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery; D003243:Consciousness / Q000187:drug effects; D003399:Craniotomy; D005283:Fentanyl / Q000008:administration & dosage; D015600:Glasgow Coma Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D007430:Intraoperative Care; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000601:surgery; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors