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. 2007 Feb;106(2):210-6.
doi: 10.3171/jns.2007.106.2.210.

Prospective evaluation of pain and analgesic use following major elective intracranial surgery

Allan Gottschalk  1 , Lauren C Berkow, Robert D Stevens, Marek Mirski, Richard E Thompson, Elizabeth D White, Jon D Weingart, Donlin M Long, Myron Yaster
Affiliations

Prospective evaluation of pain and analgesic use following major elective intracranial surgery

Allan Gottschalk et al. J Neurosurg. 2007 Feb.

Abstract

Object: Opioid administration after major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect the postoperative neurological examination. The authors conducted a prospective study to evaluate the incidence, severity, and treatment of postoperative pain in patients who underwent major intracranial surgery.

Methods: One hundred eighty-seven patients (77 men and 110 women, mean age 52 +/- 15 years, mean weight 78.1 +/- 19.9 kg) underwent either supratentorial (129 patients) or infratentorial (58 patients) procedures. Sixty-nine percent of the patients reported experiencing moderate to severe pain (> or =4 on a 0-10 scale) during the 1st postoperative day. Pain scores greater than or equal to 4 persisted in 48% on the 2nd postoperative day. Approximately 80% of patients were treated with acetaminophen on the 1st postoperative day, whereas opioids (primarily intravenous fentanyl) were administered to 58%. Compared with patients who underwent supratentorial procedures, those who underwent infratentorial procedures reported more severe pain at rest (mean score 4.9 +/- 2.2 compared with 3.8 +/- 2.6; p = 0.015) and with movement (mean score 6.3 +/- 2.6 compared with 4.5 +/- 2.7; p < 0.001) on the 1st postoperative day. On both the 1st and 2nd postoperative days, patients who underwent infratentorial procedures received greater quantities of opioid (p < or = 0.019) and nonopioid (p < or = 0.013) analgesics than those who underwent supratentorial procedures. Patients' dissatisfaction with analgesic therapy was significantly associated with elevated pain levels on the first 2 postoperative days (p < 0.001).

Conclusions: In contrast to prevailing assumptions, the study findings reveal that most patients undergoing elective major intracranial surgery will experience moderate to severe pain for the first 2 days after surgery and that this pain is often inadequately treated.

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Comment in

  • Pain control after craniotomy: off balance on the tightrope?
    Durieux ME, Himmelseher S. Durieux ME, et al. J Neurosurg. 2007 Feb;106(2):207-9. doi: 10.3171/jns.2007.106.2.207. J Neurosurg. 2007. PMID: 17410700 No abstract available.
  • Pain and the craniotomy.
    Kincaid MS, Lam AM. Kincaid MS, et al. J Neurosurg. 2007 Jun;106(6):1136-7; author reply 1137. doi: 10.3171/jns.2007.106.6.1136a. J Neurosurg. 2007. PMID: 17564193 No abstract available.

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