Comparative Analysis of Analgesic Mechanisms in Pediatric Craniotomy and Craniectomy Patients

Introduction: Due to the invasive nature of the craniotomies, perioperative and postoperative pain must be considered in the management. This study aims to assess current analgesic practices and compare individual sources of analgesics used in pediatric craniotomies.

Methods: A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the PRISMA guidelines to highlight articles assessing analgesics in pediatric craniotomies.

Results: 20 articles were included in our analysis: 13 retrospective reviews (1750 patients) and 7 case reports (11 patients). Of the retrospective studies, the average age was 8.30±1.91 years, and 4 papers reported sex with 184 males (54.3%). The primary etiology was tumors (135, 50.8%) followed by congenital anomalies (134, 50.4%). Most patients had frontal (277, 22.8%) and/or supratentorial (233, 39.0%) operations per 4 and 2 studies, respectively. Opioids were the most used perioperative and postoperative analgesic method for induction (912, 80.4%, 7 studies) and maintenance (1028, 60.0%, 9 studies). However, while NSAIDs were the second most common induction method (230, 20.3%), sedatives were the second most common maintenance method (657, 38.3%). Most patients experienced improved postoperative outcome associated with analgesic use (584, 76.4%, 2 studies). Of the 11 case report patients (5 males, 45.5%), the average age was 13±3.2 years. 6 patients (54.5%) presented with epilepsy while 5 (45.5%) presented with tumors. Most tumors were supratentorial (6, 85.7%) and/or temporal (5, 71.4%). All 11 patients had morphine and codeine for both induction and maintenance. Fentanyl was the next most common analgesic for induction (7, 63.6%) and maintenance (5, 45.5%). Only 1 patient (9.09%) experienced neurologic deficits at final follow-up.

Conclusion : While an established protocol for analgesic use in pediatric craniotomy patients has yet to be defined, our study demonstrates a high prevalence of opioid use as a primary method in both induction and maintenance.