Postoperative Analgesia for Supratentorial Craniotomy
Özlem Korkmaz Dilmen1, Eren Fatma Akçıl1, Yusuf Tunalı1, Esra Sultan Karabulut1, Mois Bahar2, Fatiş Altındaş1, Hayriye Vehid3, Ercüment Yentür4
1University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care
2VKF, American Hospital, Department of General Intensive Care Unit
3University of Istanbul, Cerrahpasa School of Medicine, Department of Biostatistics
4Istanbul Bilim University, Department of Anesthesiology and Intensive Care
BACKGROUND: Optimal analgesic therapy is very important as pain may cause severe problems. However there is no consensus regarding analgesic regimen for post-craniotomy pain exists. This study aimed to investigate the effects of morphine and non-opioid analgesics on postcraniotomy pain. METHODS: This prospective, randomized, double blind, placebo controlled study included 83 patients (ASA I-III) aged between 18-70 years scheduled for elective supratentorial craniotomy. Patients presenting with aphasia, GCS less than 15, addiction, chronic pain, raised intracranial pressure, allergies to any of the study drugs, hepatic or renal dysfunction, were excluded from the study. Intravenous dexketoprofen, paracetamol and metamizol were investigated for their effects on pain intensity, morphine consumption and morphine related side effects during the first 24 hours following supratentorial craniotomy. Patients were treated with morphine based patient controlled analgesia for 24 hours following surgery and randomized to receive supplemental IV dexketoprofen 50mg, paracetamol 1g, metamizol 1g or placebo. The primary endpoint was pain intensity defined by VAS(0-10), secondary endpoints were morphine consumption and related side effects. The assumption that a difference of2 units on VAS is clinically relevant, we defined the effect size to be 2, with an estimated SD±2. Setting α equal to 0.05 and β equal to 0.9, we calculated a sample size of 18 patients per group. Statistical analysis was performed using SPSS for Windows 15.0. RESULTS: When the whole study period was analyzed with repeated measures of ANOVA, the pain intensity, cumulative morphine consumption and related side effects were not different among the groups (p>0.05). CONCLUSION: This study showed that the use of morphine based PCA reduced mean VAS below 4 and prevented moderate to severe postoperative pain in patients undergoing supratentorial craniotomy. Although we could not demonstrate statistically significant effect of supplemental analgesics on morphine consumption, it was lower in dexketoprofen and metamizol groups than control group.
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