The effect of craniotomy location on postoperative pain and nausea.

Purpose: At least one retrospective study has suggested that the need for postoperative control of pain and nausea depends on the location of the cranial surgery. This prospective study was performed to examine the hypothesis that patients who have had infratentorial craniotomy experience more severe pain and more frequent nausea than those with supratentorial procedures.

Methods: We compared postoperative outcomes in 28 patients with infratentorial craniotomy, 53 with supratentorial craniotomy, and 47 with complex spinal cord surgery (the control group). Anesthesia was standardized for all three groups and the concentration of isoflurane was titrated to keep mean arterial pressure within 30% of preoperative values. Severity of pain and frequency of nausea and vomiting were recorded for 24 h after surgery. Pain was assessed with a verbal pain score scale of 0-10, with 10 being the worst pain imaginable. Data were collected for 24 h postoperatively.

Results: Because nausea and pain diminish drastically 2 h after surgery, pairwise differences were assessed at each point within the first 2 h. Within 30 min of extubation, median pain scores in the supratentorial and spine groups rose to 2 and in the infratentorial group to 5. The statistical differences between groups were not significant ( P > 0.06) by logistic regression. Also, the incidence of nausea was not significantly different (57% supratentorial, 57% spine, 67% infratentorial; P = 0.62) by Dunn's procedure.

Conclusion: There were no significant differences in the severity of pain or the frequency of nausea based on the craniotomy site.