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Postoperative Pain Management Following Craniosynostosis Repair

Current Practices and Future Directions

Brown, Stav, BS*; Yao, Amy, MD; Sanati-Mehrizy, Paymon, MD; Zackai, Sheemon P., MD; Taub, Peter J., MD, FACS

Journal of Craniofacial Surgery: May 2019 - Volume 30 - Issue 3 - p 721–729
doi: 10.1097/SCS.0000000000005008
Original Articles
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Background: Postoperative analgesia following craniosynostosis repair is a clinical challenge for plastic and reconstructive surgeons. There is a paucity of published data on the postoperative pain associated with craniosynostosis repair procedures and the prescribed analgesia varies with different unit protocols. The authors sought to summarize the current knowledge of the postoperative analgesia following craniosynostosis repair by reviewing the literature for existing regimens, clinical outcomes, and recommendations.

Methods: Two independent investigators conducted a literature search of the Pubmed, Cochrane, and Google Scholar databases for relevant clinical studies. Studies were abstracted for procedure type, postoperative pain management protocol, pain scores, side effects, complications, and clinical recommendations.

Results: Ten studies describing the use of analgesic agents in open craniosynostosis surgery from 2000 to 2018 were fully reviewed, comprising a total of 431 patients undergoing surgical procedures using a combination regimen of narcotic and nonnarcotic agents (n = 315) and nonnarcotic agents alone (n = 116).

Conclusion: Multimodal analgesia is the primary regimen used following open craniosynostosis repair procedures. Opioids are a critical component in pain management regimens, relieving patient discomfort. However, due to the deleterious effects that come with their prolonged use, intravenous acetaminophen is currently used as an alternative in many centers. The preferred mode of pain medication administration in the pediatric population is increasingly via the intravenous route which ensures that a full dose of pain medication is given. The authors suggest the use of dexmedetomidine, both an adjunct to intravenous acetaminophen and as a substitute for morphine due to its superior safety and efficacy profile.

*Sackler School of Medicine at Tel Aviv University, Tel Aviv, Israel

Department of Surgery, Division of Plastic and Reconstructive Surgery

Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.

Address correspondence and reprint requests to Stav Brown, BS, Sackler School of Medicine, Tel Aviv University, 35 Klatskin St, Tel Aviv 69978, Israel; E-mail: brown.stav@gmail.com

Received 23 June, 2018

Accepted 31 July, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.