Table 3 An overview of characteristics and analgesic protocols for postoperative pain management
Author | Surgical intervention | Name of pain management drug | Dose of each drug | Complete analgesic protocol | Complications | LOS | Clinical recommendations | Significant outcomes |
|---|---|---|---|---|---|---|---|---|
Jong [27] | Cranioplasty | Isoflurane, Sevoflurane, Iso- and Sevoflurane, Acetaminophen IV or supp, Morphine IV, Fentanyl IV, Sufentanyl IV, Remifentanil IV, Piritramide IV, Propofol IV, Midazolam IV. | Single dose | 1- ‘M’ technique massage with carrier oil only, i.e., almond oil 2- ‘M’ technique massage with mandarin 1% in carrier oil | NA | NA | ‘M’ technique massage can be used as a comforting mechanism | NA |
Fearon [35] | All cranial vault remodeling procedures | Oral ibuprofen, acetaminophen, intravenous ketorolac | Intravenous ketorolac 0.5 mg, oral Ibuprofen 10 mg, acetaminophen 15 mg/kg. | Patients in the control group were given oral ibuprofen and acetaminophen only, while the treatment group was given IV ketorolac and acetaminophen only. Neither group received any postoperative narcotics and thresholds for the medications were determined by standard pediatric nursing assessments for discomfort. | Postoperative nausea and vomiting | 2 | Administer all nonnarcotic pain drugs IV | IV administation decreased severe vomiting significantly (P value < 0.001) compared to oral |
Arts [29] | Endoscopic strip craniectomy | Acetaminophen, low-dose morphine | Acetaminophen 80 mg/kg/d, low dose morphine 5–40 mg/kg/h | Mainly acetaminophen, Morphine was started, when required, at 5 lg/kg/h and increased to a maximum of 40 mg/kg/h depending on the CHIPPS score. | Decline in hemoglobin and hematocri, blood loss | NA | NA | NA |
Tuncer [37] | Anterior cranial vault, Posterior cranial vault remodeling | Ketorolac, ibuprofen, oxycodone, morphine | Morphine, Acetaminophen. Before skin incision, either a scalp block or local anesthetic infiltration was performed with 1 mL/kg of 0.25% levobupivacain, associated with epinephrine (0.01 mg/mL) in case of infiltration | 10 mg/kg ibuprofen; 0.25 mg/kg IV ketorolac | The discharge hemoglobin is lower in the ketorolac group compared to the control group | NA | NA | NA |
Chiaretti [10] | NA | Remifentanil | Remifentanil 0.25 Ìg/kg/min | Rf was delivered at 0.25 μg/kg/min via continuous infusion, 1 h after admission to the pediatric intensive care unit (PICU). The treatment was continued for 12 h postoperatively. | 1 episode of urinary retention | NA | NA | NA |
Warren [31] | NA | Morphine | Morphine 10 to 40 μg/kg/h | 10 to 40 μg/kg/h on a continuous morphine infusion order form. The infusion was titrated by the nurses within the rate parameters, based on the patient’s level of pain. | N/V | NA | NA | NA |
Xu [2] | Posterior cranial vault expansion | Morphine, dexmedetomidine, acetaminophen | For patient 1: 1 mg morphine, dexmedetomidine 0.5 mcg/kg/h, acetaminophen 75 mg Q6H For patient 2: dexmedetomidine 0.2 mcg/kg/h, IV acetaminophen 86 mg Q6H, and morphine 0.4 mg Q3H PRN. | No clear protocol due to the study design | None | NA | NA | NA |
Zubovic [33] | Endoscopic repair & open cranial vault remodeling | Acetaminophen,acetaminophen & ibuprofen, oxycodone | Oxycodone 5 mg/5 mL | Oxycodone 5 mg/5 mL suspension was the only opioid prescribed at discharge. The most common dosing applied was 0.05 mg/kg | NA | NA | NA | NA |
Marel [28] | NA | Acetaminophen | Orally 20 mg/kg, rectal 40 mg/kg | Patients received 20 mg/kg acetaminophen either orally (n = 20) or rectally (n = 20) every 6 h after a rectal loading dose (40 mg/kg) | NA | NA | NA | NA |