The effect of craniotomy location on postoperative pain and nausea.
OBJECTIVE
At least one retrospective study has suggested that the need for postoperative control of pain and nausea depends on the location of the cranial surgery. This prospective study was performed to examine the hypothesis that patients who have had infratentorial craniotomy experience more severe pain and more frequent nausea than those with supratentorial procedures.


METHODS
We compared postoperative outcomes in 28 patients with infratentorial craniotomy, 53 with supratentorial craniotomy, and 47 with complex spinal cord surgery (the control group). Anesthesia was standardized for all three groups and the concentration of isoflurane was titrated to keep mean arterial pressure within 30% of preoperative values. Severity of pain and frequency of nausea and vomiting were recorded for 24 h after surgery. Pain was assessed with a verbal pain score scale of 0-10, with 10 being the worst pain imaginable. Data were collected for 24 h postoperatively.


RESULTS
Because nausea and pain diminish drastically 2 h after surgery, pairwise differences were assessed at each point within the first 2 h. Within 30 min of extubation, median pain scores in the supratentorial and spine groups rose to 2 and in the infratentorial group to 5. The statistical differences between groups were not significant ( P > 0.06) by logistic regression. Also, the incidence of nausea was not significantly different (57% supratentorial, 57% spine, 67% infratentorial; P = 0.62) by Dunn's procedure.


CONCLUSIONS
There were no significant differences in the severity of pain or the frequency of nausea based on the craniotomy site.
Irefin
Samuel A
SA
Department of General Anesthesiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue-E31, Cleveland, OH 44195, USA.
Schubert
Armin
A
Bloomfield
Eric L
EL
DeBoer
Glenn E
GE
Mascha
Edward J
EJ
Ebrahim
Zeyd Y
ZY
D003399:Craniotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015192:Infratentorial Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000209:etiology*; D020250:Postoperative Nausea and Vomiting / Q000209:etiology*; D011446:Prospective Studies; D013116:Spinal Cord / Q000601:surgery; D015173:Supratentorial Neoplasms / Q000601:surgery; D013997:Time Factors