Post-craniotomy pain in a paediatric population

Abstract

There is little information about analgesia use or pain experienced in children after neurosurgery. The aims of this study were to assess the degree of pain experienced by children after neurosurgery and the analgesic regimens used, and to identify factors associated with significant pain. Data for 52 children who underwent craniotomy were collected contemporaneously over 72 hours. Data included demographics, intraoperative surgical and anaesthetic details, postoperative medications and postoperative pain scores as routinely collected by nursing staff Pain was also assessed by an independent observer (auditor) using an age and developmentally appropriate tool, on a scale from zero to 10. For most of the time the children had little or no pain. Over the 72 hours the median pain score recorded by nursing staff was 0.7 and by the auditor was 1.3. However in spite of the low median scores, 42% of children had at least one episode of a pain score > or = 3. Postoperatively, 71% of children received parenteral morphine, 92% of children received paracetamol, 35% oxycodone, 19% oral codeine, 4% tramadol and 2% ibuprofen. Using multivariate regression, duration of procedure was the only factor associated with parenteral morphine use for > 24 hours, and older age was the only factor associated with having an episode of pain scoring > 3. No episodes of significant respiratory depression were noted. At our institution, children receive multimodal analgesia after neurosurgery, commonly parenteral morphine, and this is usually associated with low pain scores.