Background: The anesthetic management of supratentorial craniotomy necessitates tight intraoperative hemodynamic control. This type of surgery may also be associated to substantial postoperative pain. We aimed at evaluating the influence of regional scalp block (SB) on hemodynamic stability during the noxious events of supratentorial craniotomies and total intravenous anesthesia, its influence on intraoperative anesthetic agents' consumption, and its effect on postoperative pain control.Methods: Sixty patients scheduled for elective craniotomy were prospectively enrolled. Patient, anesthesiologist, and neurosurgeon were blind to the random performance of SB with either levobupivacaine 0.33% (Group SB, n=30) or the same volume of saline (Group CO, placebo group, n=30). General anesthesia was induced and maintained using target-controlled infusions of remifentanil and propofol that were adjusted according to hemodynamic parameters and State Entropy of the electroencephalogram (SE), respectively. Mean arterial pressure (MAP), heart rate (HR), SE, and propofol and remifentanil effect-site concentrations (Ce) were recorded at the time of SB (Baseline), and 0, 1, 3, and 5 minutes after skull-pin fixation (SP), skin incision (SI), craniotomy (CR), and dura-mater incision (DM). Morphine consumption and postoperative pain intensity (0-10 visual analogue scale, VAS) were recorded 1, 3, 6, 24 and 48 hours after surgery. Propofol and remifentanil overall infusion rates were also recorded. Data were analyzed using two-tailed Student unpaired t-tests, two-way mixed-design ANOVA and Tukey's HSD tests for post-hoc comparisons as appropriate.Results: Demographics and length of anesthetic procedure of Group CO and SB were comparable. SP, SI and CR were associated with a significantly higher MAP in Group CO than in Group SB, at least at one of the time points of recording surrounding those noxious events. This was not the case at DM. Similarly, HR was significantly higher in Group CO than in Group SB during SP and SI, at least at one of the points of recording, but not during CR and DM. Propofol and remifentanil Ce and overall infusion rates were significantly higher in Group CO than in Group SB, except for propofol 4 Ce during SP. Postoperative pain VAS and cumulative morphine consumption were significantly higher in Group CO than in Group SB.Conclusions: In supratentorial craniotomies, SB improves hemodynamic control during noxious events, and provides adequate and prolonged postoperative pain control as compared to placebo.

IntroductionPosterolateral-approached total hip arthroplasty (PLTHA) is followed by moderate to severe postoperative pain. Suprainguinal fascia iliaca compartment block (SFICB) has been proposed as a promising analgesia technique.MethodsData from 86 patients scheduled for PLTHA with spinal anesthesia were analyzed in this prospective randomized controlled trial. Patients were randomly divided into two groups of 43 patients each. As opposed to the control group (group C), ropivacaine group (group R) received additional SFICB using 40 mL of 0.375% ropivacaine. As primary endpoint, blind observers noted total morphine consumption at postoperative 48 hours. Secondary endpoints were pain at rest and mobilization on 0–10 Numeric Rating Scale (rest and dynamic NRS) at fixed time points (1 hour and 6 hours after surgery, and at day 1 and day 2 at 8:00, 13:00 and 18:00 hours), walking performance at day 1 and day 2; postoperative complications including morphine-related side effects or orthostatic intolerance symptoms such as dizziness, nausea, blurred vision or vasovagal syncope.ResultsA 48-hour morphine consumption (mg; median (IQR)) was significantly lower in group R than in group C (11 (8.5–15.5)) vs 26 (21–33.5), p<0001), as well as incidence of morphine-related side effects such as nausea at day 1 (p=0.04) and day 2 (p<0.01). Rest and dynamic NRS were globally significantly lower in group R than in group C (p<0.01). Group R showed less orthostatic intolerance at day 1 (p<0.001) and day 2 (p<0.01) and better functional walking performance at day 1 (<0.001) and day 2 (<0.001).DiscussionIn PLTHA, SFICB provides opioid sparing, improved postoperative pain control, and enhanced functional recovery.Trial registration numberNCT04574479.

Background There is no defined gold standard for pain management after video-assisted thoracic surgery (VATS) for pneumothorax. In addition to systemic analgesia, various loco-regional analgesic techniques have been proposed but remain poorly evaluated in this context. We aimed to assess the analgesic efficacy of several of these techniques for the management of postoperative pain. Methods We conducted a monocentric prospective observational cohort study from February 2017 to April 2018 in patients suffering from spontaneous pneumothorax and scheduled for VATS ( n = 59). Patients received systemic analgesia (i) alone ( n = 15); (ii) combined with a continuous paravertebral block ( n = 9); (iii) combined with a continuous serratus plane block ( n = 19); or (iv) single-shot serratus plane block ( n = 16) as decided by the attending physician. Pain scores and analgesic-related side effects were prospectively collected by an independent observer during the first postoperative 72 h. The primary endpoint criterion was the cumulative oral morphine consumption at the end of the third postoperative day. Statistical analysis used univariate and multivariate step-by-step forward logistic regression models to determine risk factors associated with the main criteria. Results Mean pain scores and morphine consumption were not significantly different between the 4 groups. In the multivariate analysis, the use of a continuous serratus plane block through a catheter was the only technique associated with a reduced incidence of high-dose oral morphine consumption (OR 0.09–95%CI [0.01–0.79], p = 0.03). Conclusion This study suggests that serratus plane block combined with continuous infusion through a catheter may have some benefits, although further studies are needed to confirm these results and determine the true place of the serratus plane block in pain management after VATS for pneumothorax.

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