The Role of Opioids in Post-operative Pain Management Following Craniosynostosis Repair: Current Practices and Future Directions
Stav Brown, BS1, Amy Yao, MD2, Paymon Sanati-Mehrizy, MD3, Sheemon P. Zackai, MD4, Peter J. Taub, MD FACS3.
1Sackler School of Medicine, Tel Aviv, Israel, 2Icahn School of Medicine at Mount Sinai, New York, NY, USA, 3Department of Surgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA, 4Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Background: Postoperative analgesia following craniosynostosis repair is a clinical challenge for craniofacial surgeons. There is a paucity of published data on the postoperative pain associated with craniosynostosis repair and the prescribed analgesia varies with different unit protocols. The authors sought to summarize the current knowledge of the postoperative analgesia following craniosynostosis repair and explore the role of opioids in post-operative pain regimens by reviewing the literature for existing regimens, clinical outcomes, and recommendations.
Methods: Two independent investigators conducted a systematic literature search of the Pubmed, Cochrane, and Google Scholar databases. Studies were abstracted for procedure type, postoperative pain management protocol, pain scores, side effects, complications, and clinical recommendations.
Results: Ten studies from 2000-2018 were deemed relevant, comprising a total of 431 patients undergoing surgical procedures using a combination regimen of narcotic and non-narcotic agents (n=315) and non-narcotic agents alone (n=116).
Conclusions: Multimodal analgesia is the primary regimen used following open craniosynostosis repair. Opioids are a critical component in many pain management regimens. However, due to the potentially deleterious effects associated with their prolonged use, intravenous acetaminophen has recently emerged as an alternative in many centers. Other popular protocols used by proponents of nonnarcotic postoperative pain management are described in detail. Despite the lack of significant side effects, current studies have not found a reduction in the duration of postoperative opiate use following Scalp Nerve Blocks. The preferred mode of pain medication administration in the pediatric population is increasingly via the intravenous route. The authors share their experience using a novel Dexmedetomidine (Precedex) based protocol following craniosynostosis repair due to its superior safety and efficacy profile.
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