{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:11:21Z","timestamp":1772827881889,"version":"3.50.1"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective matched cohort study included patients &lt; 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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 \u00b1 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.peds24334","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T21:21:58Z","timestamp":1737753718000},"page":"379-384","source":"Crossref","is-referenced-by-count":0,"title":["Standardizing postoperative pain control for decompression of pediatric Chiari type I malformation by limiting narcotic usage"],"prefix":"10.3171","volume":"35","author":[{"given":"Rebecca A.","family":"Reynolds","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda V.","family":"Jenson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kentlee","family":"Battick","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Hartnett-Wright","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis F.","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Jallo","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. Hassan A.","family":"Akbari","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew D.","family":"Smyth","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Johns Hopkins All Children\u2019s Hospital, St. Petersburg, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","article-title":"Drug Overdose Deaths: Facts and Figures","unstructured":"Drug Overdose Deaths: Facts and Figures. 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