Aim
To conduct an integrative review to examine evidence of pain and
associated symptoms in adult (≥ 21 years of age), post-craniotomy,
brain tumor patients hospitalized on intensive care units.
Background
Healthcare providers believe craniotomies are less painful than other
surgical procedures. Understanding how post-craniotomy pain unfolds over
time will help inform patient care and aid in future research and policy
development.
Design
Systematic literature search to identify relevant literature.
Information abstracted using the Theory of Unpleasant Symptoms’
concepts of influencing factors, symptom clusters and patient performance.
Inclusion criteria were indexed, peer-reviewed, full-length,
English-language articles. Keywords were ‘traumatic brain
injury,’ ‘pain, post-operative,’ ‘brain
injuries,’ ‘postoperative pain,’
‘craniotomy,’ ‘decompressive craniectomy,’
and ‘trephining.’
Data sources
Medline, OVID, PubMed and CINAHL databases from 2000 –
2014.
Review Method
Cooper’s five-stage integrative review method was used to
assess and synthesize literature.
Results
The search yielded 115 manuscripts, with 26 meeting inclusion
criteria. Most studies were randomized, controlled trials conducted outside
of the United States. All tested pharmacological pain interventions.
Post-craniotomy brain tumor pain was well-documented and associated with
nausea, vomiting and changes in blood pressure and impacted patient length
of hospital stay, but there was no consensus for how best to treat such
pain.
Conclusion
The Theory of Unpleasant Symptoms provided structure to the search.
Post-craniotomy pain is experienced by patients, but associated symptoms and
impact on patient performance remain poorly understood. Further research is
needed to improve understanding and management of post-craniotomy pain in
this population.