Safety and Utility of Scheduled Nonnarcotic Analgesic Medications in Children Undergoing Craniotomy for Brain Tumor

BACKGROUND: We have reported that a scheduled nonnarcotic analgesic regimen after dorsal lumbar rhizotomy and Chiari I malformation decompression is efficacious in managing postoperative pain in children. To date, this regimen has not been analyzed in children after brain tumor biopsy or resection. OBJECTIVE: To elucidate the safety and utility of such an analgesic protocol in these patients. PATIENTS AND METHODS: A database review was conducted to identify children who received a scheduled dose of alternating acetaminophen and ibuprofen after craniotomy for tumor biopsy or resection, and postoperative imaging was evaluated. RESULTS: Fifty-one children who met the inclusion criteria were identified. On postoperative imaging, 17.67% had routine, postoperative blood in the resection cavity according to both radiology and neurosurgical review. One patient had moderate postoperative bleeding in the tumor cavity. Overall, 44 of the 51 patients (86.3%) required no or minimal narcotic medication for pain. CONCLUSION: A scheduled regimen of nonsteroidal antiinflammatory drugs given in alternating doses immediately after craniotomy for tumor biopsy or resection and throughout hospitalization did not result in any significant postoperative hemorrhage in our patient series.