Journal article
Standardizing postoperative pain control for decompression of pediatric Chiari type I malformation by limiting narcotic usage
Journal of neurosurgery. Pediatrics, Vol.35(4), pp.379-384
04/2025
DOI: 10.3171/2024.11.PEDS24334
PMID: 39854718
Abstract
The aim of this study was to assess the effectiveness of a postoperative multimodal pain control protocol on perioperative pain scores in children undergoing decompression for Chiari type I malformation (CM-I).
This retrospective matched cohort study included patients < 21 years of age who underwent elective suboccipital craniectomy and C1 laminectomy for CM-I with or without duraplasty at a single center from January 2020 to July 2023. A standardized, multimodal postoperative pain protocol was implemented in August 2021 that did not use narcotic patient-controlled analgesia. Pre- and postprotocol cohorts were compared. The primary outcome was average perioperative pain score. Secondary outcomes included postoperative length of stay (LOS), narcotic usage, and antiemetic usage.
Thirty-four children met the inclusion criteria (17 preprotocol, 17 postprotocol). Fifty-three percent were female (18/34). The mean patient age was 7.0 ± 5.0 years. After implementation of the pain protocol, noninferior average pain scores (p = 0.08) and less antiemetic administration (p = 0.048) were found across both surgery types. Equivalent inpatient LOS (p = 0.78), narcotic prescriptions at discharge (p = 0.73), and milliequivalents of morphine used (p = 0.55) were also found. Bone-only decompression was completed in 65% of patients (n = 22/34, 11 in each pre- and postprotocol group) with 12 of 34 undergoing duraplasty (6 in each pre- and postprotocol group). Patients who underwent posterior fossa decompression with duraplasty had a significantly longer LOS (p = 0.003), more overall narcotic usage (p = 0.015), and lower pain scores (p = 0.047) compared with those who underwent decompression without duraplasty.
Patients undergoing a CM-I decompression had noninferior postoperative pain control and required less antiemetic dosing after implementation of a multimodal pain protocol. Neurosurgeons should consider a postoperative multimodal pain regimen for their patients with CM-I who undergo decompression with or without duraplasty.
Details
- Title: Subtitle
- Standardizing postoperative pain control for decompression of pediatric Chiari type I malformation by limiting narcotic usage
- Creators
- Rebecca A Reynolds - University of IowaAmanda V Jenson - Johns Hopkins All Children's HospitalKentlee Battick - Johns Hopkins UniversitySara Hartnett-Wright - Johns Hopkins All Children's HospitalLuis F Rodriguez - Johns Hopkins All Children's HospitalGeorge Jallo - Johns Hopkins All Children's HospitalS Hassan A Akbari - Johns Hopkins All Children's HospitalMatthew D Smyth - Johns Hopkins All Children's Hospital
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery. Pediatrics, Vol.35(4), pp.379-384
- DOI
- 10.3171/2024.11.PEDS24334
- PMID
- 39854718
- NLM abbreviation
- J Neurosurg Pediatr
- ISSN
- 1933-0715
- eISSN
- 1933-0715
- Publisher
- American Association of Neurological Surgeons
- Language
- English
- Electronic publication date
- 01/24/2025
- Date published
- 04/2025
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984775018102771
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