Craniosynostosis Surgery: a Painless Procedure? A Single Institution's Experience in Post-operative Pain Management
Alexandra Macmillan, MBBS, Deepa Kattail, MD, Muhammad Faateh, MBBS, Rachel Pedreira, BA, Leila Musavi, BA, Regina Cho, BS, Joseph Lopez, MD MBA, Amir H. Dorafshar, MbChB.
Johns Hopkins Hospital, Baltimore, MD, USA.
Craniosynostosis is an extremely complex, invasive procedure often assumed to be associated with minimal pain. The purpose of this study was to investigate pain management trends at a tertiary academic institution.
Retrospective chart review was performed of all surgical repairs for primary craniosynostosis at The Johns Hopkins Hospital from January 2009 to May 2013. Demographic information, admission data, and post-operative pain management were recorded.
57 patients were identified. Mean age was 12.6 months, mean length of stay was 3.2 days. 86% were admitted to ICU, the remainder admitted to an inpatient floor. 93% were prescribed IV parent/nurse controlled analgesia (PCA), with fentanyl (73.6%) being most utilized. 98.3% were prescribed acetaminophen. No patients received NSAIDs. 98.3% were prescribed enteral opioids and oxycodone was the only opioid utilized. Transition from IV to enteral opioids occurred on post-operative day (POD) 0-2 in 45.6%, day 2-3 in in 52.7%, and after day 4 in 1.8%. 89.3% were prescribed opioids for discharge, most commonly oxycodone.
Despite pain service consultation and immediate initiation of IV PCA use, over 40% of patients were transitioned to oral opioids by POD 1 and mean length of stay was 3 days. Our results indicate that utilization of opioids via PCA can provide effective pain control without delaying transition to oral analgesics or discharge to home.
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