title: Pain after Major Craniotomy in a University Hospital: A Prospective Cohort Study.
abstract: BACKGROUND
  Pain after major craniotomy has been believed to be less severe than the other operations.
  
  
  OBJECTIVE
  To determine the incidence and risk factors of moderate to severe pain after major craniotomy.
  
  
  METHODS
  This is a prospective observational study in a neurosurgical intensive care unit and wards of a university, tertiary hospital. After institutional IRB approval, patients undergoing major craniotomy during May 2011-August 2012 were interviewed preoperatively and 24 and 48 hours postoperatively. Demographic data, preoperative anxiety scores, operative data and postoperative pain characteristics were recorded.
  
  
  RESULTS
  Two hundred and eighty patients completed the study. The incidence of moderate to severe pain was 75%. Mean pain score during 24 and 48 hours were 5.5 ± 2.7 and 3.5 ± 2.6, respectively. Univariate analysis identified age under 45 years and perioperative steroid therapy as predictors of moderate to severe postoperative pain. Using multivariate analysis, only age under 45 years was a significant risk factor. Patients' satisfaction scores were good in both mild and moderate to severe pain groups (9.49 ± 1.08 and 8.37 ± 1.76). During postoperative period, almost all of the patients received intravenous opioid and oral acetaminophen for pain treatment. No respiratory depression occurred, but postoperative nausea and vomiting occurred in 51.7% and pruritus in 23.6%.
  
  
  CONCLUSIONS
  Incidence of pain after craniotomy was high especially in younger age group, which is not in accordance with all similar reports. However we believe pain management after major craniotomy in our hospital requires improvement.
authors: Sirilak
authors: S
authors: Suksompong
authors: Nophanan
authors: N
authors: Chaikittisilpa
authors: Tadrawee
authors: T
authors: Rutchadawong
authors: Ekawut
authors: E
authors: Chankaew
authors: Benno
authors: B
authors: von Bormann
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000082:Acetaminophen