Suboptimal pain treatment after craniotomy.

INTRODUCTION Only few studies have investigated pain, nausea, sedation and analgesic strategies in post-craniotomy patients. The aim of this observational study was to explore pain, nausea, sedation and analgesic procedures after craniotomy, and to evaluate the quality of current analgesic therapy administered to post-craniotomy patients. MATERIAL AND METHODS A total of 59 patients undergoing supratentorial or infratentorial craniotomy were included over a three-month period. The intensity of pain, nausea and sedation was evaluated at 1, 2, 4, 8 and 24 h after extubation. Post-operative analgesic consumption at 0-48 h after extubation was noted. Post-operative morphine consumption in relation to gender, surgical procedure, administration of preoperative steroids and application of surgical drains was evaluated. RESULTS Fifty patients completed the study. After the first post-operative hour, 56% suffered from moderate-to-severe pain, which decreased to 38% at 24 h post-operatively. Patients receiving preoperative steroids experienced significantly less pain than patients who did not receive preoperative steroids (p = 0.04). The mean post-operative morphine consumption 0-48 h post-operatively was 28.8 mg (± 23.6 mg). Only 52% of the patients received the planned amount of acetaminophen of 4,000 mg/day. CONCLUSION Pain following craniotomy is moderate to severe in a substantial number of patients. The quality of the analgesic treatment leaves room for improvement. Administration of preoperative steroids may reduce post-craniotomy pain. FUNDING not relevant. TRIAL REGISTRATION not relevant.