Prevention and treatment of postoperative pain in pediatric patients undergone craniotomy: Systematic review of clinical evidence

Background: Prevention and treatment of postoperative pain after craniotomy in pediatric patients is an open and challenging clinical problem due to limited epidemiological data and significant concerns on safety of the most common analgesics in neurosurgical patients. We reviewed the literature to evaluate the possible available strategies in pain management in pediatric patients. Methods: The systematic review was performed in accordance with PRISMA statement recommendations. PUBMED, EMBASE and Scopus databases were queried. Inclusion criteria were: randomized controlled trials, prospective and retrospective observational studies published before 2020 and reported postoperative pain management after craniotomy (i.e. including studies accomplished after craniotomy, craniectomy and reconstructive surgery) in children population (neonates to 18 years old). Results: A total of 11 studies - 4 randomized controlled, 5 prospective observational and 2 retrospective met criteria for inclusion. The selected studies reported data from a total of 1077 patients, with age ranging between neonates to 18 years, 52% male and 48% female. Opioids are still the most commonly used drugs. Paracetamol and NSAIDs are frequently used as adjuvants to reduce postoperative opioid requirements. Data on potential hypocoagulation due to the antiplatelet effect of NSAIDs are lacking. Selective scalp block provides lower pain scores in early postoperative period. Conclusion: Clinical evidence on prevention and treatment of postoperative pain in pediatric patients undergone craniotomy is still sparse. Available data prove that a multimodal approach, realized as the use a combination of opioids, paracetamol/NSAIDs and regional anesthesia, is effective and rarely associate with complications.

Automated summary

Prevention and treatment of postoperative pain in pediatric patients after craniotomy remains a challenging problem with limited clinical evidence. A multimodal approach, combining opioids, paracetamol/NSAIDs, and regional anesthesia, is effective and associated with low risk of complications.