Department of Neurosurgery, The Catholic University of Korea Assessment of postoperative pain in patients treated with elective craniotomy Department of Neurosurgery, St. Vincent’s Hospital, The Catholic University of Korea Jae Hyun Park Bok Neu Yu, Il Sup Kim, Jae Taek Hong, Jae Hoon Sung, Byung Chul Son, Sang Won Lee, Seung-Ho Yang

Introduction Little is known about perioperative pain in patients undergoing neurosurgical procedures. Less analgesic management for major intracranial surgery Concern that opioids will affect neurological examination after Op. Few reports in the practical setting in Korea. Purpose Serial assessment of postoperative pain in patients undergoing elective craniotomy for the treatment of various neurosurgical diseases. Evaluate the correlation between intensity of postoperative pain and other components

Material & Method Inclusion criteria Exclusion criteria 18세 이상 Elective craniotomy Normal mental function Good performance and oriented patients Exclusion criteria Newly developed postoperative neurological deficit and mental change Psychological or severe medical disease Other lesion that cause pain in the body Emergent operation, Burr hole trephination, TSA Reoperation Infection Daily VAS (Visual analogue scale) assessment Components : Operation time, Location of operation, length of wound, Head pin fixation, past history, BMI, Usage of opioid, Date of transfer to general ward

Results 40 patients / Single institute <Characteristics> M:F = 21:19 Mean age 51.2 years (Range : 23~76 years) Diagnosis Meningioma : 10 Hemifacial spasm : 5 Astrocytoma : 3 Hemangioblastoma : 3 Ruptured aneurysm: 2 Glioblastoma multiforme, Metastatic brain tumor, Schwannoma, TB granuloma, Epidermoid cyst, Chronic subdural hematoma etc. Past history DM : 2 / HBP : 13 Smoking : 6 BMI : 18.07 ~ 33.15 (mean : 23.28)

Results VAS score Postoperative days

Results <Considered factors > Location : Supratentorial (31 patients) / Infratentorial (9 patients) Operation time : 160min ~ 733min (mean : 350.5min) Length of wound : 7cm ~ 30cm (mean : 14.6cm) Head pin fixation : 32 patients (8 patients ► X) Usage of opioid : 9 patients (31 patients ► X) Date of transfer to G/W : POD #1~7 (mean : 2.4) Change of VAS score after transfer : -5 ~ +5 (mean : +0.075)

Results

Results

Comparison with literatures Institute No. Disease Severe pain Factors Multi-center in Europe (JNS 2006) 649 Brain and spine surgery Spine > Brain surgery Patients with preoperative pain Johns Hopkins (JNS 2007) 187 Elective craniotomy The first 2 days after surgery Infratentorial procedures St. Vincent’s Hospital 40 Opioid, Wound length, G/W transfer

Discussion Severe pain : First 2 days after surgery ICU care ► adequate & active management for pain is needed Length of wound : 15cm 이상 group < 15cm 미만 group Limited data span Diagnosis (Aneurysm, Hemifacial spasm, Acoustic schwannoma etc.) Location of wound (Infratentorial) Opioid : 사용하지 않은 group < 사용한 group Usage of opioid because of severe pain More opioid must be needed More pain after transfer to general ward Associated with ambulation Less attention by doctors and nurses

Conclusion Despite the limited data span, this survey shows that it is necessary to consider active treatment for the severe pain after elective craniotomy which were often neglected before. Should pay more attention to postoperative pain after transfer to general ward. Perform prospective and observational study including large numbers of patients.