Pain Management Following Suturectomy for Craniosynostosis Repair: A Retrospective Analysis

Background: Craniosynostosis is a congenital condition characterized by premature fusion of cranial sutures, occurring in ~1/2000 to 2500 live births. Surgical treatment is required to prevent cranial deformity and increased intracranial pressure, and it is associated with substantial postoperative pain; however, standardized protocols for postoperative pain management remain limited. Methods: A retrospective chart review at a tertiary care center identified 63 pediatric patients who underwent suturectomy for craniosynostosis between 2019 and 2025. Patients were divided into 2 groups according to postoperative analgesic strategy: continuous opioid infusion (n = 38) or limited infusion or bolus-based analgesia (n = 25). Data collected included operative variables, postoperative pain scores, physiological parameters, complications, and intensive care unit (ICU) and total hospital length of stay (LOS). Negative binomial regression analysis was used to evaluate the association between infusion duration and LOS. Results: Patients managed without continuous opioid infusion had a significantly shorter hospital LOS compared with those receiving continuous infusion (2.0 ± 0.9 versus 3.1 ± 1.9 d, P = 0.01). ICU LOS was similar between the groups (1.17 ± 0.83 versus 1.37 ± 0.53 d, P = 0.31), pain scores at discharge were low and comparable, and no significant differences were observed in physiological parameters, complications, or rehospitalization. Regression analysis demonstrated that each additional hour of opioid infusion was associated with a 2.3% increase in hospital LOS (incidence rate ratio: 1.0227; 95% CI: 1.0068–1.0391; P = 0.005). Conclusions: Bolus-based postoperative analgesia following suturectomy provides effective pain control and is associated with shorter hospitalization compared with continuous opioid infusion. Prolonged opioid infusion duration is associated with increased LOS.