1. 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

2. 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

3. 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

4. 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 : ~ (mean : 23.28)

5. Results
VAS score
Postoperative days

6. 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 : )

7. Results

8. Results

9. 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

10. 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

11. 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.