Anesthesiology

The study find that the in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However; therefore  the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. Because This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery.

Postoperative analgesia

Three hundred and twenty patients age 1 to 12-years old who underwent craniotomy are randomly assign to receive 4 different regimens of patient-controlled analgesia. Because The formulas use are as follows: Control group included normal saline 100 ml; with a background infusion of 2 ml/h, bolus 0.5 ml; Fentanyl group is use with a background infusion of 0.1–0.2 μg/k·h, bolus 0.1–0.2 μg/kg; Morphine group is use with a background infusion of 10–20 μg/kg·h, bolus 10–20 μg/kg; while Tramadol group is use with a background infusion of 100–400 μg/kg·h, bolus 100–200 μg/kg.

Postoperative pain scores and analgesia-relate complication are record respectively. Comparative analysis is perform between the four groups. In comparison of all groups with each other; therefore lower pain scores are shows at 1 h and 8 h after surgery in Morphine group versus Tramadol; Fentanyl and Control groups (P < 0.05).

Included normal saline

Both Tramadol and Fentanyl groups showed lower pain scores in comparison to Control group (P < 0.05). Nausea and vomiting are observe more in Tramadol group in comparison to all other groups during the 48 h of PCIA usage after operation (P = 0.020). Much more rescue medicines including ibuprofen and morphine are use in Control group (CI = 0.000–0.019). Changes in consciousness and respiratory depression are not observe in study groups.

Moderate-to-severe pain was observed in a total of 56 (17.5%) of the study population. Multiple regression analysis for identifying risk factors for moderate-to-severe pain revealed that; younger children (OR = 1.161, 1.027–1.312, P = 0.017), occipital craniotomy (OR = 0.374, 0.155–0.905, P = 0.029); and morphine treatment (OR = 0.077, 0.021–0.281, P < 0.001) are the relevant factors.

Lower pain scores

Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations.Pain after craniotomy is a frequent source of concern and controversy. Over the past decade, but  several studies primarily in adult patient have revealed that moderate-to-severe pain is common in patients after major craniotomy.

Furthermore, very few studies have assessed pain or analgesic requirements in pediatric patients following neurosurgery, primarily due to fear of opioid analgesics masking alterations in the postoperative neurological exam and delaying detection of intracranial postoperative complications. Postoperative pain in pediatric neurosurgical patients appears to be underestimated often.

Inadequate pain control in children after major craniotomy may contribute to significant anxiety, hypertension, shivering, and emesis, which may in turn increase intracranial pressure and cause bleeding. Therefore, although frequently overlooked, postoperative analgesia in children after craniotomy is important.