Postoperative Craniotomy Pain Management in Pediatric Patients: A Systematic Review

Post-craniotomy pain is predominantly superficial, sug gesting somatic origin [8] originating from the scalp, muscles, and soft tissue, with subsequent activation of the pain path way from manipulation of the dura mater [9] . Post-cranioto my pain is usually localized to the surgical site and surround ing structures and results from incision and traction during surgery [10] . The nature of post-craniotomy pain is described Abstract Background: There is increasing evidence supporting increased pain intensity following neurosurgical procedures. There are different approaches to analgesia following craniotomy and cranioplasty, but there is limited consensus on postcraniotomy pain management especially in the pediatric population. Methods: A comprehensive online search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Literature was taken from PubMed, EMBASE, Science Direct, ProQuest, and Google Scholar databases. Human comparative studies including randomized controlled trials and cohort studies evaluating pain scores after neurosurgery in pediatric patients were included in the review. Results: A total of 3 RCTs and 6 cohort studies met the inclusion criteria. The heterogeneity of the studies included did not allow for data pooling and statistical analysis. All studies evaluated the efficacy of pharmacologic interventions in pediatric patients who underwent craniotomy by measuring postoperative pain scores. Continuous opioid infusions postoperatively provided favorable postoperative pain control in pediatric patients without serious opioid-induced adverse complications. Intraoperative doses of opioids for preemptive analgesia had favorable outcomes but still lack evidence. Non-opioid analgesics are suitable adjuncts to postoperative opioids to enhance analgesia and minimize adverse events use of local anesthetics as local scalp infiltration or nerve block for children resulted in lower postoperative pain scores and longer time to first rescue analgesia compared to placebo, but still need further studies. Conclusion: Opioids remain as mainstay treatment for children who underwent neurosurgery but specific recommendation on the method and timing of delivery of opioids cannot be drawn from this review. The use of non-opioid analgesics and local anesthetics for local infiltration and nerve block need further research. There is a lack of high-quality evidence on this field, and additional research is necessary to improve pain management after craniotomy in the pediatric population.