The Efficacy of Intravenous Patient-Controlled Analgesia After Intracranial Surgery of the Posterior Fossa

Morad, Athir; Winters, Bradford D.; Stevens, Robert; White, Elizabeth; Weingart, Jon; Yaster, Myron; Gottschalk, Allan

doi:10.1213/ane.0b013e31823f0c5a

Cited by 33 publications

(43 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Perhaps not surprisingly, pediatric patients who received IV PCA or PNCA received more opioid analgesics than those who received nurse administered PRN analgesics. These results are the same as previously reported in adult patients undergoing craniotomy surgery . However, unlike the adult studies, this increase in opioid consumption seen with PCA or PNCA did not result in differences in pain scores or in patient satisfaction.…”

Section: Discussionsupporting

confidence: 89%

“…Patients receiving PCA or PNCA received nearly three to five times as much opioid as did patients receiving nurse administered PRN opioids. Unlike studies in adult patients, this increase in opioid consumption did not result in differences in pain scores or in patient satisfaction . Indeed, in this study, there were no differences in average pain score, length of stay, or parental satisfaction with care regardless of the method of analgesic therapy.…”

Section: Discussioncontrasting

confidence: 72%

“…In the traditional PRN approach, a patient must complain of pain and ask for pain relief. The responding nurse must respond to and assess the patient, then locate, prepare, and administer the ordered medication at a fixed dose and time interval . Thus, even in the best of circumstances, there is a lag time inherent in asking for and receiving analgesia.…”

Section: Discussionmentioning

confidence: 99%

“…Historically, the pain associated with intracranial surgery has been under‐treated because of the fear that the use of opioids may interfere with the neurologic examination or lead to its deterioration . Much of the information concerning the quality, duration, and treatment of pain following cranial surgery is anecdotal .…”

Section: Introductionmentioning

confidence: 99%

“…On the other hand, a growing body of published studies in adult patients report that pain following intracranial surgery is in fact common, often intense, and under‐treated . Failure to adequately treat pain in other postoperative conditions is associated with poor outcome .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Pain management following major intracranial surgery in pediatric patients: a prospective cohort study in three academic children's hospitals

Maxwell

Buckley

Kudchadkar

et al. 2014

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

Introduction Pain management following major intracranial surgery is often limited by a presumed lack of need and a concern that opioids will adversely affect postoperative outcome and interfere with the neurologic examination. Nevertheless, evidence in adults is accumulating that these patients suffer moderate to severe pain and this pain is often under-treated. The purpose of this prospective, clinical observational cohort study was to assess the incidence of pain, prescribed analgesics, methods of analgesic delivery, and patient/parent satisfaction in pediatric patients undergoing cranial surgery at 3 major university children’s hospitals. Methods After obtaining IRB and parental consent (and when applicable, patient assent), children who underwent cranial surgery for cancer, epilepsy, vascular malformations, and craniofacial reconstruction were studied. Neither intraoperative anesthetic management nor postoperative pain management was standardized, but were based on institutional routine. Patients were evaluated daily by a study investigator and by chart review for pain scores using age appropriate, validated tools (FLACC, Faces Pain Scale-Revised, Wong Baker Faces Scale or Self-Report on a 0–10 scale), for patient/parent satisfaction using a subset of the NRC Picker satisfaction tool and in adolescents a modified QoR-40, and for the frequency, mode of administration, and type of analgesic provided. Finally, the incidence of opioid-induced side effects, specifically nausea, vomiting, pruritus, altered level of consciousness, and need for emergency diagnostic radiologic studies for altered neurologic examination were recorded. Data are provided as mean ± SD. Results Two hundred children (98:102 M:F), averaging 7.8 ± 5.8 years old (range 2 mos to 18.5 yr) and 32.2 ± 23.0 kg (range 4.5 to 111.6 kg) undergoing craniectomy (51), craniotomy (96), and craniofacial reconstruction (53) were studied. Despite considerable variation in mode and route of analgesic administration, there were no differences in average pain score, length of hospital stay, or parental satisfaction with care. Interestingly, opioid induced side effects were not related to total daily opioid consumption, site of surgery, or method of opioid delivery. The most common side effect was vomiting. No patient developed respiratory depression or altered mental status secondary to analgesic therapy. Regardless of age or procedure, once eating, most patients were treated with oral oxycodone and/or acetaminophen. Conclusions Despite considerable variation in modality and route of analgesic administration, there were no differences in average pain score, length of stay, or parental satisfaction with care. Pain scores were low, side effects were minimal, and parental satisfaction was high, providing equipoise for future blinded prospective randomized trials in this patient population.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations