title: Safety and utility of scheduled nonnarcotic analgesic medications in children undergoing craniotomy for brain tumor.
abstract: BACKGROUND
  We have reported that a scheduled nonnarcotic analgesic regimen after dorsal lumbar rhizotomy and Chiari I malformation decompression is efficacious in managing postoperative pain in children. To date, this regimen has not been analyzed in children after brain tumor biopsy or resection.
  
  
  OBJECTIVE
  To elucidate the safety and utility of such an analgesic protocol in these patients.
  
  
  METHODS
  A database review was conducted to identify children who received a scheduled dose of alternating acetaminophen and ibuprofen after craniotomy for tumor biopsy or resection, and postoperative imaging was evaluated.
  
  
  RESULTS
  Fifty-one children who met the inclusion criteria were identified. On postoperative imaging, 17.67% had routine, postoperative blood in the resection cavity according to both radiology and neurosurgical review. One patient had moderate postoperative bleeding in the tumor cavity. Overall, 44 of the 51 patients (86.3%) required no or minimal narcotic medication for pain.
  
  
  CONCLUSIONS
  A scheduled regimen of nonsteroidal antiinflammatory drugs given in alternating doses immediately after craniotomy for tumor biopsy or resection and throughout hospitalization did not result in any significant postoperative hemorrhage in our patient series.
authors.affiliation: Section of Pediatric Neurosurgery, Children's Hospital, Birmingham, Alabama 35233, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Waters
authors.forename: R Shane
authors.initials: RS
authors.lastname: Tubbs
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Rozzelle
authors.forename: John C
authors.initials: JC
authors.lastname: Wellons
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Blount
authors.forename: W Jerry
authors.initials: WJ
authors.lastname: Oakes
mesh_terms: D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001706:Biopsy; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007223:Infant; D020300:Intracranial Hemorrhages / Q000139:chemically induced / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D007052:Ibuprofen