The effect of craniotomy location on postoperative pain and nausea

Irefin, Samuel A.; Schubert, Armin; Bloomfield, Eric L.; DeBoer, Glenn; Mascha, Edward J.; Ebrahim, Zeyd

doi:10.1007/s00540-003-0182-8

Cited by 48 publications

(46 citation statements)

References 10 publications

(6 reference statements)

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“…In this regard, our results are in agreement with other studies that report no interaction between PONV and craniotomy location. 3,4 The fact that PONV is negatively correlated with the postoperative use of steroids in this study goes along with recent evidence in the literature showing that dexamethasone administration reduces the risk of PONV by about 26%. 10 The present study has several limitations.…”

Section: Discussionsupporting

confidence: 74%

“…Similar trends were reported in a prospective study that included 52 neurosurgical patients: temporal and occipital craniotomies were associated with a higher frequency of excruciating pain. 3 Finally, Irefin et al 4 compared the intensity of pain in the immediate postoperative period (first two hours) in patients undergoing infratentorial craniotomy (n = 28) vs supratentorial craniotomy (n = 53). Again, a trend towards higher pain scores in the infratentorial group was obtained.…”

Section: Discussionmentioning

confidence: 99%

“…1 Observations from a few studies indicate, mainly as a secondary finding, that the severity of pain might be linked to the site of craniotomy. [1][2][3][4] As the issue has not been clearly resolved, it is important to characterize the occurrence and severity of pain in relation to the location of craniotomy to improve clinical strategies to ensure optimal postoperative pain management of neurosurgical patients.…”

mentioning

confidence: 99%

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Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Thibault

Girard

Moumdjian

et al. 2007

Can J Anesth/J Can Anesth

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Objective: This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy. Methods:After Research Ethics Board approval, data were collected from the charts of all patients who underwent a craniotomy at our institution between January 2004 and December 2005. The severity of post-craniotomy pain was assessed by collecting scores obtained using an 11-point verbal rating scale and calculating the cumulative analgesic requirements for the first 48 hr postoperatively. Data were compared according to the craniotomy location. Results:Data from 299 patients was available for analysis. On average, 76% of patients experienced moderate to severe postoperative pain. Frontal craniotomy was associated with lower pain scores than four of six craniotomy sites analyzed, with 49% of patients reporting mild pain, a significant difference (P < 0.05) compared with all other groups except for parietal craniotomies. Frontal craniotomy patients also had lower opioid analgesic requirements compared to patients who underwent posterior fossa craniotomy (P < 0.05). Logistic regression analysis showed that craniotomy location (P < 0.0001) and age (P = 0.004) were both independent predictors of the intensity of postoperative pain, with lower pain scores as age increased. Postoperative use of steroids, gender and presence of preoperative pain were not statistically linked to postoperative pain intensity. The prevalence of postoperative nausea and vomiting was 56% and it did not vary according to the location of craniotomy. Conclusion:This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Thibault

Girard

Moumdjian

et al. 2007

Can J Anesth/J Can Anesth

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“…5,[13][14][15][16] In a previous retrospective study, we found that 76% of craniotomy patients experience moderate to severe pain during this time period. 13 In concordance with other studies, we also showed that infratentorial surgery was associated with the greatest opioid consumption.…”

Section: Discussionmentioning

confidence: 86%

“…[5][6][7][8][9][10][11][12] The focus of these studies was on the evaluation of pain in supratentorial surgery, whereas patients undergoing infratentorial or occipital neurosurgery report more severe pain with increased opioid consumption. [13][14][15][16] The superficial cervical plexus block (SCPB) blocks the branches of the occipital nerves and may be a good alternative to opioid analgesia in this patient population. 17 We designed this randomized controlled double-blind study to compare the quality of transitional analgesia provided by SCPB with that provided by intravenous morphine following general anesthesia consisting of remifentanil and sevoflurane for infratentorial or occipital craniotomy.…”

Section: Résumémentioning

confidence: 99%

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Girard

Quentin

Charbonneau

et al. 2010

Can J Anesth/J Can Anesth

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Background In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanilbased anesthesia for infratentorial or occipital craniotomy. Methods In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mgÁkg -1 iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine. Results Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups. Conclusion Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies. RésuméContexte Dans le cadre de cette e´tude, nous avons compare´la qualite´de l'analge´sie transitionnelle produite par un bloc bilate´ral du plexus cervical superficiel (SCPB) ou par la morphine a`la suite d'une anesthe´sie au re´mifentanil lors d'une craniotomie sous-tentorielle ou occipitale. Méthode Dans cette e´tude randomise´e et contrôle´e en double aveugle, 30 patients ayant subi une craniotomie sous-tentorielle ou occipitale ont e´te´divise´s ale´atoirement en deux groupes: le groupe morphine (morphine 0,1 mgÁkg -1 intraveineuse apre`s la fermeture de la dure-me`re et un SCPB effectue´avec 20 mL de solution sale´e à 0,9 % a`la fin de la chirurgie) ou le groupe bloc (10 mL de solution sale´e à 0,9 % intraveineuse au lieu de la morphine apre`s la fermeture de la dure-me`re, et un SCPB effectueá vec 20 mL d'un me´lange 1:1 de bupivacaı¨ne a`0,5 % et de lidocaı¨ne a`2 % à la fin de la chirurgie). La douleur postope´ratoire a e´te´mesure´e à une, deux, quatre, huit, 12, 16 et 24 h a`l'aide d'une e´chelle d'e´valuation nume´rique

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Acute Pain Management Protocol for Cranial Procedures

Barre

Adhikary

2023

First Aid Perioperative Ultrasound

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The effect of craniotomy location on postoperative pain and nausea

Abstract: There were no significant differences in the severity of pain or the frequency of nausea based on the craniotomy site.

Cited by 48 publications

References 10 publications

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Craniotomy site influences postoperative pain following neurosurgical procedures: a retrospective study

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

Acute Pain Management Protocol for Cranial Procedures

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