Acute postoperative pain in pediatric neurosurgery: state of the problem and effectiveness of modern pain relief methods

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OBJECTIVE

To evaluate severity of postoperative pain syndrome in children after various neurosurgical interventions; to analyze the effectiveness of prevention and correction of postoperative pain in these patients.

MATERIAL AND METHODS

A prospective observational study included 306 children after neurosurgery. Postoperative pain syndrome was assessed using FLACC scales in children aged 0-6 years and VAS scale in older children. Measurements were performed in 24 hours after weaning from ventilator. There were several groups depending on surgery: patients with craniosynostosis, posterior cranial fossa pathology, supratentorial pathology, patients who underwent minimally invasive neurosurgical interventions and spinal surgeries. Comparison of indicators was performed using the Mann-Whitney test. To assess the relationship between neurosurgical intervention and the likelihood of moderate-to-severe pain, we used odds ratio (OR) with 95% confidence interval (95% CI).

RESULTS

The study included 159 children aged 2 months-6 years and 147 older children. The probability of severe pain syndrome after correction of craniosynostosis, spinal surgery and subtentorial craniotomy was higher compared to traditional supratentorial craniotomy: OR=8.56; 95% CI (3.05—24.00) (p<0.0001) for spinal neurosurgery; OR=3.29; 95% CI (1.79—6.06) (p=0.0001) for subtentorial craniotomy; OR=2.29; 95% CI (1.11—4.69) (p=0.02) for correction of craniosynostosis.

CONCLUSION

Severe pain syndrome is common in children after neurosurgery. The authors observed less severe pain syndrome after minimally invasive craniotomy and higher pain intensity after spinal neurosurgery, subtentorial craniotomy and correction of craniosynostosis.

Keywords:

pain

analgesia

nociception

pediatric neurosurgery

neuroanesthesiology

Authors:

Tere V.A.

Burdenko Neurosurgery Center

ORCID: 0000-0003-4247-8953

Kulikov A.S.

Burdenko Neurosurgery Center

ORCID: 0000-0002-2852-6544

Satanin L.A.

Burdenko Neurosurgery Center

ORCID: 0000-0003-2051-1855

Lubnin A.Yu.

Burdenko Neurosurgical Center

RSCI AuthorID: 370609
Scopus AuthorID: 57192157123
ORCID: 0000-0003-2595-5877

Received:

08.05.2024

Accepted:

12.09.2024

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