Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study.
OBJECTIVE
This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy.


METHODS
After Research Ethics Board approval, data were collected from the charts of all patients who underwent a craniotomy at our institution between January 2004 and December 2005. The severity of post-craniotomy pain was assessed by collecting scores obtained using an 11-point verbal rating scale and calculating the cumulative analgesic requirements for the first 48 hr postoperatively. Data were compared according to the craniotomy location.


RESULTS
Data from 299 patients was available for analysis. On average, 76% of patients experienced moderate to severe postoperative pain. Frontal craniotomy was associated with lower pain scores than four of six craniotomy sites analyzed, with 49% of patients reporting mild pain, a significant difference (P < 0.05) compared with all other groups except for parietal craniotomies. Frontal craniotomy patients also had lower opioid analgesic requirements compared to patients who underwent posterior fossa craniotomy (P < 0.05). Logistic regression analysis showed that craniotomy location (P < 0.0001) and age (P = 0.004) were both independent predictors of the intensity of postoperative pain, with lower pain scores as age increased. Postoperative use of steroids, gender and presence of preoperative pain were not statistically linked to postoperative pain intensity. The prevalence of postoperative nausea and vomiting was 56% and it did not vary according to the location of craniotomy.


CONCLUSIONS
This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.
Thibault
Maxime
M
Department of Anesthesiology, CHUM, Hôpital Notre-Dame, 1560 Sherbrooke East, Montréal, Québec H2L 4M1, Canada.
Girard
François
F
Moumdjian
Robert
R
Chouinard
Philippe
P
Boudreault
Daniel
D
Ruel
Monique
M
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003061:Codeine / Q000008:administration & dosage / Q000627:therapeutic use; D003388:Cranial Fossa, Posterior / Q000601:surgery; D003399:Craniotomy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D012189:Retrospective Studies; D013256:Steroids / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D013256:Steroids; D003061:Codeine