Pain post neurosurgery in the paediatric population: a cohort study (Accepted as a poster)

Abstract

Aims: This audit was to determine the incidence and severity of post neurosurgical pain, analgesic use and predictors of significant pain following paediatric neurosurgery.Background: Research in the adult population has evaluated incidence and severity [1–5] of post neurosurgical pain, and effectiveness of different post neurosurgical analgesic regimens. In contrast there are few studies describing the incidence or management of pain after paediatric neurosurgery.Method: A prospective audit of patients who underwent elective or emergency intra‐cranial procedures at the Royal Children's Hospital was performed from September 2007 to April 2008. Pain scores were obtained from nursing documentation and bi‐daily by the auditor using pain measurement tools. Use of analgesia was also noted. Details of surgical procedure and intra‐operative anaesthesia management were recorded. Multivariate regression was used to identify factors associated with use of parenteral opioids >24 hr or unacceptable pain (pain scores ≥ 3).Results: Eighty‐eight patients (48 male, 40 female) were included. Low median pain scores over 72 postoperative hours were reported from nursing documentation [0.79 (IQR: 0.3–1.53)] and auditor scores [1.33 (IQR: 0.17–3.08)]. Fifty (56.8%) patients required parenteral opioids, 34.1% as infusion and 22.7% as PCA, and 34.1% used parenteral morphine for >24 hr. A multivariate regression revealed younger age and longer surgical duration as factors associated with postoperative parenteral morphine use > 24 hr (P < 0.05). The only factor associated with pain scores ≥ 3 in a regression analysis of patients of all procedural types was older age (P < 0.05). Conclusion: This audit reported that the majority of paediatric neurosurgical patients received postoperative parenteral opioids. The majority also experienced relatively little pain. The low pain scores observed indicated effective postoperative pain management.References1 de Gray LC, Mata BF. Acute and chronic pain following craniotomy: a review. Anaesthesia 2005; 60: 693–704.2 Gottschalk A, Barlow LC, Stevens RD, Mir ski M, Thompson RE, White ED, Weingarten JD, Long DM, Yester M. Prospective evaluation of pain and analgesic use following major elective intracranial surgery. Journal of Neurosurgery 2007; 106: 210–216.3 Ire fin SA, Schubert A, Bloomfield EL, DeBeers GE, Mache EJ, Abraham ZY. The effect of craniotomy location on postoperative pain and nausea. Journal of Anesthesia 2003; 17: 227–231.4 Kilmer M, Ruben JF, Amman J, Burner U, Klein J, Verbrugge SJ. Pain in neurosurgically treated patients: a prospective observational study. J Neurosurg 2006; 104: 350–359.5 Quiney N, Cooper R, Stoneham M, Walters F. Pain after craniotomy. A time for reappraisal? British Journal of Neurosurgery 1996; 10: 295–299.