Pain Management for Nonsyndromic Craniosynostosis

Adequate Analgesia in a Pediatric Cohort?

Deepa Kattail, Alexandra Macmillan, Leila Musavi, Rachel Pedreira, Muhammad Faateh, Regina Cho, Joseph Lopez, Amir Dorafshar

Research output: Contribution to journalReview article

Abstract

Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n=54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40mg/kg/d in morphine milligram equivalent (MME) (±1.07mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n=6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P=0.006), weight (P=0.009), and day of transition to enteral opioids (P<0.001); association with emesis was trending toward significance (P=0.054). There was no association between overall LOS and amount of opioids administered postoperatively (P=0.68). Postoperative emesis did not have any significant association with age, sex, weight, total amount of postoperative opioid administered, use of ketorolac, or intraoperative steroid use. Conclusion: Open craniosynostosis repair is associated with high levels of pain and low utilization of nonopioid analgesics. Strategies to improve pain, decrease emesis and LOS include implementation of multimodal analgesia period and avoidance of enteral medications in the first 24hours after surgery.

Original languageEnglish (US)
Pages (from-to)1148-1153
Number of pages6
JournalJournal of Craniofacial Surgery
Volume29
Issue number5
DOIs
StatePublished - Jul 1 2018

Fingerprint

Craniosynostoses
Pain Management
Analgesia
Opioid Analgesics
Vomiting
Length of Stay
Pediatrics
Postoperative Pain
Ketorolac
Small Intestine
Pain
Morphine
Non-Narcotic Analgesics
Weights and Measures
Postoperative Nausea and Vomiting
Postoperative Period
Analgesics
Steroids
Demography
Population

Keywords

  • Craniofacial surgery
  • craniosynostosis
  • opioids
  • pain management
  • pediatrics

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Kattail, D., Macmillan, A., Musavi, L., Pedreira, R., Faateh, M., Cho, R., ... Dorafshar, A. (2018). Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort? Journal of Craniofacial Surgery, 29(5), 1148-1153. https://doi.org/10.1097/SCS.0000000000004406

Pain Management for Nonsyndromic Craniosynostosis : Adequate Analgesia in a Pediatric Cohort? / Kattail, Deepa; Macmillan, Alexandra; Musavi, Leila; Pedreira, Rachel; Faateh, Muhammad; Cho, Regina; Lopez, Joseph; Dorafshar, Amir.

In: Journal of Craniofacial Surgery, Vol. 29, No. 5, 01.07.2018, p. 1148-1153.

Research output: Contribution to journalReview article

Kattail, D, Macmillan, A, Musavi, L, Pedreira, R, Faateh, M, Cho, R, Lopez, J & Dorafshar, A 2018, 'Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort?', Journal of Craniofacial Surgery, vol. 29, no. 5, pp. 1148-1153. https://doi.org/10.1097/SCS.0000000000004406
Kattail, Deepa ; Macmillan, Alexandra ; Musavi, Leila ; Pedreira, Rachel ; Faateh, Muhammad ; Cho, Regina ; Lopez, Joseph ; Dorafshar, Amir. / Pain Management for Nonsyndromic Craniosynostosis : Adequate Analgesia in a Pediatric Cohort?. In: Journal of Craniofacial Surgery. 2018 ; Vol. 29, No. 5. pp. 1148-1153.
@article{f9ebfb1703134e0fa6568fd953cd4bb6,
title = "Pain Management for Nonsyndromic Craniosynostosis: Adequate Analgesia in a Pediatric Cohort?",
abstract = "Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n=54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5{\%}) and day 1 (60.9{\%}). Opioid administered in postoperative period was 1.40mg/kg/d in morphine milligram equivalent (MME) (±1.07mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5{\%}) or day 2 (49.1{\%}). Ketorolac was administered to 11.1{\%} (n=6). Emesis was documented in 50{\%} of patients. LOS revealed a positive association with age (P=0.006), weight (P=0.009), and day of transition to enteral opioids (P<0.001); association with emesis was trending toward significance (P=0.054). There was no association between overall LOS and amount of opioids administered postoperatively (P=0.68). Postoperative emesis did not have any significant association with age, sex, weight, total amount of postoperative opioid administered, use of ketorolac, or intraoperative steroid use. Conclusion: Open craniosynostosis repair is associated with high levels of pain and low utilization of nonopioid analgesics. Strategies to improve pain, decrease emesis and LOS include implementation of multimodal analgesia period and avoidance of enteral medications in the first 24hours after surgery.",
keywords = "Craniofacial surgery, craniosynostosis, opioids, pain management, pediatrics",
author = "Deepa Kattail and Alexandra Macmillan and Leila Musavi and Rachel Pedreira and Muhammad Faateh and Regina Cho and Joseph Lopez and Amir Dorafshar",
year = "2018",
month = "7",
day = "1",
doi = "10.1097/SCS.0000000000004406",
language = "English (US)",
volume = "29",
pages = "1148--1153",
journal = "Journal of Craniofacial Surgery",
issn = "1049-2275",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Pain Management for Nonsyndromic Craniosynostosis

T2 - Adequate Analgesia in a Pediatric Cohort?

AU - Kattail, Deepa

AU - Macmillan, Alexandra

AU - Musavi, Leila

AU - Pedreira, Rachel

AU - Faateh, Muhammad

AU - Cho, Regina

AU - Lopez, Joseph

AU - Dorafshar, Amir

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n=54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40mg/kg/d in morphine milligram equivalent (MME) (±1.07mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n=6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P=0.006), weight (P=0.009), and day of transition to enteral opioids (P<0.001); association with emesis was trending toward significance (P=0.054). There was no association between overall LOS and amount of opioids administered postoperatively (P=0.68). Postoperative emesis did not have any significant association with age, sex, weight, total amount of postoperative opioid administered, use of ketorolac, or intraoperative steroid use. Conclusion: Open craniosynostosis repair is associated with high levels of pain and low utilization of nonopioid analgesics. Strategies to improve pain, decrease emesis and LOS include implementation of multimodal analgesia period and avoidance of enteral medications in the first 24hours after surgery.

AB - Background: Postoperative pain following open craniosynostosis repair has not been studied extensively and is sometimes thought to be inconsequential. The purpose of this study was to assess postoperative pain in this pediatric population. Methods: We performed a retrospective chart review of patients (n=54) undergoing primary open craniosynostosis repair from 2010 to 2016. Demographics, length of stay (LOS), pain scores, emesis events, and perioperative analgesics were reviewed. Multivariable regression models were designed to assess for independent predictors of LOS and emesis. Results: A high proportion had moderate to severe pain on postoperative day 0 (56.5%) and day 1 (60.9%). Opioid administered in postoperative period was 1.40mg/kg/d in morphine milligram equivalent (MME) (±1.07mg/kg/d MME). Majority of patients transitioned to enteral opioids on postoperative day 1 (24.5%) or day 2 (49.1%). Ketorolac was administered to 11.1% (n=6). Emesis was documented in 50% of patients. LOS revealed a positive association with age (P=0.006), weight (P=0.009), and day of transition to enteral opioids (P<0.001); association with emesis was trending toward significance (P=0.054). There was no association between overall LOS and amount of opioids administered postoperatively (P=0.68). Postoperative emesis did not have any significant association with age, sex, weight, total amount of postoperative opioid administered, use of ketorolac, or intraoperative steroid use. Conclusion: Open craniosynostosis repair is associated with high levels of pain and low utilization of nonopioid analgesics. Strategies to improve pain, decrease emesis and LOS include implementation of multimodal analgesia period and avoidance of enteral medications in the first 24hours after surgery.

KW - Craniofacial surgery

KW - craniosynostosis

KW - opioids

KW - pain management

KW - pediatrics

UR - http://www.scopus.com/inward/record.url?scp=85050231725&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85050231725&partnerID=8YFLogxK

U2 - 10.1097/SCS.0000000000004406

DO - 10.1097/SCS.0000000000004406

M3 - Review article

VL - 29

SP - 1148

EP - 1153

JO - Journal of Craniofacial Surgery

JF - Journal of Craniofacial Surgery

SN - 1049-2275

IS - 5

ER -