• Alfio Bronco, Domenico Pietrini, Massimo Lamperti, Marta Somaini, Federica Tosi, Laura Minguell del Lungo, Elena Zeimantz, Miriam Tumolo, Elisabetta Lampugnani, Marinella Astuto, Francesco Perna, Nicola Zadra, Luisa Meneghini, Valentina Benucci, Leonardo Bussolin, Anna Scolari, Alessandra Savioli, Bruno G Locatelli, Viviana Prussiani, Michela Cazzaniga, Fabio Mazzoleni, Carlo Giussani, Matteo Rota, Catherine E Ferland, and Pablo M Ingelmo.
• Department of Anesthesia and Intensive Care I, Ospedale San Gerardo di Monza, Monza, Italy; Deparment of Experimental Medicine, University of Milano-Bicocca, Monza, Italy.
• Paediatr Anaesth. 2014 Jul 1;24(7):781-7.

BackgroundThere is very few information regarding pain after craniotomy in children.ObjectivesThis multicentre observational study assessed the incidence of pain after major craniotomy in children.MethodsAfter IRB approval, 213 infants and children who were <10 years old and undergoing major craniotomy were consecutively enrolled in nine Italian hospitals. Pain intensity, analgesic therapy, and adverse effects were evaluated on the first 2 days after surgery. Moderate to severe pain was defined as a median FLACC or NRS score ≥ 4 points. Severe pain was defined as a median FLACC or NRS score ≥ 7 points.ResultsData of 206 children were included in the analysis. The overall postoperative median 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 and second day after surgery. Rectal codeine was the most common weak opiod used. Remifentanil and morphine were the strong opioids widely used in PICU and in general wards, respectively. Longer procedures were associated with moderate to severe pain (OR 1.30; CI 1.07-1.57) or severe pain (OR 1.41; 1.09-1.84; P < 0.05). There were no significant associations between complications, pain intensity, and analgesic therapy.ConclusionChildren receiving multimodal analgesia experience little or no pain after major craniotomy. Longer surgical procedures correlate with an increased risk of having postoperative pain.© 2014 John Wiley & Sons Ltd.

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