Pain severity and pain control following intracranial surgery

Abstract

Objective To explore the incidence and severity of acute post-craniotomy pain in Maharaj Nakorn Chiang Mai Hospital, including the adequacy of routine pain relief practices.MethodsPostoperative analgesia prescribed for patients undergoing elective intracranial surgery was classified into two surgical groups: the supratentorial and the infratentorial approaches. Demographic and perioperative clinical data, including the use of a scalp block and the dosage of fentanyl, were collected and analysed. Postoperative pain was assessed for three days following surgery using a numeric rating scale (NRS) or a revised non-verbal pain scale (NVPS-R). Pain medication treatment and side effects were recorded. Results Of 251 patients, 190 underwent a supratentorial craniotomy, while 61 were treated with an infratentorial approach. On the first postoperative day, the incidence of a NRS score ≥4 (moderate to severe pain) was 18.2-31.8% with NRS versus 6.4-11.1% for NVPS-R. The incidence of a pain score of zero gradually increased over time, reaching 100% in patients assessed with NVPS-R and 87% in those with NRS on day three. In the infratentorial group, a pre-incisional scalp block decreased pain scores upon arrival at the ward and for the first four-hour period after surgery (p=0.05 and 0.042, respectively). Over 90% of patients were prescribed intravenous tramadol every six hours on postoperative day one, but only 60% were given tramadol during the first 8-16 hours in the supratentorial group, while 75% of the infratentorial group received tramadol (p=0.021). ConclusionPain after intracranial surgery was effectively relieved with tramadol. NVPS-R should be investigated further to confirm its reliability as a tool for non-verbally communicating patients.