title: Prospective assessment of postoperative pain after craniotomy.
abstract: 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.
  
  
  METHODS
  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.affiliation: Department of Anesthesiology, Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Mordhorst
authors.forename: Björn
authors.initials: B
authors.lastname: Latz
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerz
authors.forename: Gregor
authors.initials: G
authors.lastname: Wisser
authors.forename: Annette
authors.initials: A
authors.lastname: Schmidt
authors.forename: Astrid
authors.initials: A
authors.lastname: Schneider
authors.forename: Annette
authors.initials: A
authors.lastname: Jahn-Eimermacher
authors.forename: Christian
authors.initials: C
authors.lastname: Werner
authors.forename: Kristin
authors.initials: K
authors.lastname: Engelhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D001921:Brain / Q000601:surgery; D003399:Craniotomy; D003422:Critical Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy; D010892:Pirinitramide / Q000627:therapeutic use; D011446:Prospective Studies; D000077149:Sevoflurane; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D010892:Pirinitramide