Incidence of pain after craniotomy in children.
BACKGROUND
There is very few information regarding pain after craniotomy in children.


OBJECTIVE
This multicentre observational study assessed the incidence of pain after major craniotomy in children.


METHODS
After IRB approval, 213 infants and children who were <10 years old and undergoing major craniotomy were consecutively enrolled in nine Italian hospitals. Pain intensity, analgesic therapy, and adverse effects were evaluated on the first 2 days after surgery. Moderate to severe pain was defined as a median FLACC or NRS score ≥ 4 points. Severe pain was defined as a median FLACC or NRS score ≥ 7 points.


RESULTS
Data of 206 children were included in the analysis. The overall postoperative median FLACC/NRS scores were 1 (IQR 0 to 2). Twenty-one children (16%) presented moderate to severe pain in the recovery room and 14 (6%) during the first and second day after surgery. Twenty-six children (19%) had severe pain in the recovery room and 4 (2%) during the first and second day after surgery. Rectal codeine was the most common weak opiod used. Remifentanil and morphine were the strong opioids widely used in PICU and in general wards, respectively. Longer procedures were associated with moderate to severe pain (OR 1.30; CI 1.07-1.57) or severe pain (OR 1.41; 1.09-1.84; P < 0.05). There were no significant associations between complications, pain intensity, and analgesic therapy.


CONCLUSIONS
Children receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.
Department of Anesthesia and Intensive Care I, Ospedale San Gerardo di Monza, Monza, Italy; Deparment of Experimental Medicine, University of Milano-Bicocca, Monza, Italy.
Alfio
A
Bronco
Domenico
D
Pietrini
Massimo
M
Lamperti
Marta
M
Somaini
Federica
F
Tosi
Laura Minguell
LM
del Lungo
Elena
E
Zeimantz
Miriam
M
Tumolo
Elisabetta
E
Lampugnani
Marinella
M
Astuto
Francesco
F
Perna
Nicola
N
Zadra
Luisa
L
Meneghini
Valentina
V
Benucci
Leonardo
L
Bussolin
Anna
A
Scolari
Alessandra
A
Savioli
Bruno G
BG
Locatelli
Viviana
V
Prussiani
Michela
M
Cazzaniga
Fabio
F
Mazzoleni
Carlo
C
Giussani
Matteo
M
Rota
Catherine E
CE
Ferland
Pablo M
PM
Ingelmo
D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors
D000700:Analgesics
analgesia; children; craniotomy; pain; postoperative pain management