Pain after craniotomy. A time for reappraisal?

Abstract

Pain and nausea were prospectively assessed in 52 patients following elective craniotomy. When assessed at 6-hourly intervals the mean pain scores in patients during the first 24 h for all types of craniotomy were relatively low. However, for a period of at least 2 h 18% of patients complained of excruciating pain, 37% of patients complained of severe pain, 29% of patients complained of moderate pain, 4% of patients complained of mild pain and only 12% of patients complained of no pain in the 24 h following craniotomy. The mean dose of codeine phosphate used within the study period was 123 mg (SD 81). No statistically significant differences in severity of pain or use of codeine phosphate were found when comparing patients undergoing craniotomy at different sites. For at least 2 h 37% of patients complained of severe nausea or vomiting, 35% of patients complained of moderate nausea and only 29% of patients reported no symptoms of nausea during the 24-h study period. Again, no statistically significant differences were found in the severity of emetic symptoms when comparing patients undergoing craniotomy at different sites. Contrary to standard assumptions, severe or moderate pain in the first 24 h after craniotomy is common and is poorly treated with codeine phosphate alone.

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

“…3,[6][7][8] Codeine is widely used on our neurosurgical ward and although the 75% overall prevalence of moderate to severe pain is within the 60 to 84% reported by others, 1-3 the present study certainly reinforces the concern that a more potent analgesic needs to be used in this surgical population.…”

“…This explanation also applies to parietal craniotomies (32% incidence of mild pain) in which only periosteum rather than muscle is incised and reflected. 3 As indicated in the logistic regression model, the preoperative presence of pain did not appear to influence the severity of postoperative pain in this study. Similarly, there was no difference in the preoperative use of analgesics between frontal craniotomy and other locations.…”

“…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.…”

“…[1][2][3] Postcraniotomy pain is described as superficial in the majority of patients, suggesting a prominent role of pericranial muscles and soft tissue in its genesis. 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 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.…”