Kattail Deepa, Macmillan Alexandra, Musavi Leila, Pedreira Rachel, Faateh Muhammad, Cho Regina, Lopez Joseph, Dorafshar Amir H
Department of Anesthesia, McMaster University, Hamilton, Canada.
Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, MD.
J Craniofac Surg. 2018 Jul;29(5):1148-1153. doi: 10.1097/SCS.0000000000004406.
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.
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.
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 1.40 mg/kg/d in morphine milligram equivalent (MME) (±1.07 mg/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.
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 24 hours after surgery.
开放性颅骨缝早闭修复术后疼痛尚未得到广泛研究，有时被认为无关紧要。本研究的目的是评估该儿科人群的术后疼痛情况。
我们对2010年至2016年接受初次开放性颅骨缝早闭修复术的患者（n = 54）进行了回顾性病历审查。对人口统计学、住院时间（LOS）、疼痛评分、呕吐事件和围手术期镇痛药进行了审查。设计多变量回归模型以评估住院时间和呕吐的独立预测因素。
很大一部分患者在术后第0天（56.5%）和第1天（60.9%）有中度至重度疼痛。术后给予的阿片类药物以吗啡毫克当量（MME）计为1.40 mg/kg/d（±1.07 mg/kg/d MME）。大多数患者在术后第1天（24.5%）或第2天（49.1%）转为肠内阿片类药物。11.1%（n = 6）的患者使用了酮咯酸。50%的患者有呕吐记录。住院时间与年龄（P = 0.006）、体重（P = 0.009）以及转为肠内阿片类药物的天数（P < 0.001）呈正相关；与呕吐的相关性呈显著趋势（P = 0.054）。总体住院时间与术后给予的阿片类药物量之间无关联（P = 0.68）。术后呕吐与年龄、性别、体重、术后给予的阿片类药物总量、酮咯酸的使用或术中类固醇的使用均无显著关联。
开放性颅骨缝早闭修复术与高水平的疼痛和非阿片类镇痛药的低利用率相关。改善疼痛、减少呕吐和住院时间的策略包括实施多模式镇痛期以及在术后24小时内避免使用肠内药物。
