Introduction: Post-operative pain control in patients undergoing craniotomy is a difficult task, requiring judicious use of pain medication. Traditionally, narcotics have been used in this setting. Their underuse may cause unnecessary pain and suffering, while overuse may lead to altered mental status, clouding the neurological exam. Recently, interest has grown in use of non-narcotics during this period. This includes IV acetaminophen, which was FDA approved for use in 2010. Previous studies in post-surgical patients have shown benefits. However, there have been no studies into its use on patients undergoing craniotomy. We propose that IV acetaminophen is more effective than narcotics in post-craniotomy period. Potential advantages include less sedation, leading to more reliable neurological exams, and more reliable pain control, both leading to faster mobilization out of bed and decreased length of stay.
Methods: This retrospective study included patients who underwent craniotomy at our institution between February-May 2014. Patients who underwent single burr hole placement or suboccipital craniotomy were excluded from the analysis. The patients were divided into 2 groups for analysis: Those who received IV acetaminophen and those who did not. 36 patients were included in the study. 19 received IV acetaminophen and 17 did not. Data points collected include demographics, extent of cranial incision, post-operative subjective pain scales, use of narcotics and length of stay.
Results: Initial results show an improvement in subjective perception of post-operative pain among patients and a subjective perception among nursing staff for decreased narcotic use. A regression analysis suggests that there is a loose correlation with use of IV acetaminophen to decreased length of stay.
Conclusions: Initial results are promising, and show that the use of IV acetaminophen has benefits in post-craniotomy patients, including improved pain control, decreased narcotic use and a trend toward decreased length of stay. Continued analysis of the data is underway.
Patient Care: Improved pain control
Decreased post-op length of stay
Improved patient satisfaction.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the limitations and risks in the use of traditional narcotics used in the post-craniotomy setting.
2) Identify the benefits of using IV acetaminophen for pain control in the post-craniotomy setting.
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