Incidence of pain after craniotomy in children

SummaryBackground: There is very few information regarding pain after craniotomyin children.Objectives: This multicentre observational study assessed the incidence ofpain after major craniotomy in children.Methods: After IRB approval, 213 infants and children who were <10 yearsold and undergoing major craniotomy were consecutively enrolled in nineItalian hospitals. Pain intensity, analgesic therapy, and adverse effects wereevaluated on the first 2 days after surgery. Moderate to severe pain wasdefined as a median FLACC or NRS score ≥4 points. Severe pain was definedas a median FLACC or NRS score ≥7 points.Results: Data of 206 children were included in the analysis. The overall postoperativemedian FLACC/NRS scores were 1 (IQR 0 to 2). Twenty-one children(16%) presented moderate to severe pain in the recovery room and 14(6%) during the first and second day after surgery. Twenty-six children(19%) had severe pain in the recovery room and 4 (2%) during the first andsecond day after surgery. Rectal codeine was the most common weak opiodused. Remifentanil and morphine were the strong opioids widely used inPICU and in general wards, respectively. Longer procedures were associatedwith moderate to severe pain (OR 1.30; CI 1.07–1.57) or severe pain (OR1.41; 1.09–1.84; P < 0.05). There were no significant associations betweencomplications, pain intensity, and analgesic therapy.