A Comparison Between Scalp Nerve Block and Morphine for Transitional Analgesia After Remifentanil-Based Anesthesia in Neurosurgery

Abstract

We compared transitional analgesia provided by scalp nerve block (SNB) or morphine after remifentanil-based anesthesia in neurosurgery. Fifty craniotomy patients were randomly divided into two groups: morphine (morphine 0.1 mg x kg(-1) IV after dural closure and an SNB performed with 20 mL of 0.9% saline at the end of surgery) and block (10 mL of 0.9% saline instead of morphine after dural closure and an SNB performed with a 1:1 mixture of bupivacaine 0.5% and lidocaine 2% at the end of surgery). Postoperative pain was assessed at 1, 2, 4, 8, 12, 16, and 24 h using a 10-point numerical rating scale. Analgesia consisted of subcutaneous codeine. Average numerical rating scale scores were similar between the two groups at each time interval. Total codeine dosage was also similar, except at 4 h postoperatively when it was higher in the block group. The delay before administration of the first dose of codeine was not statistically different between groups: 45 min (20-2880) vs 30 min (10-2880), median and range for the block and morphine group, respectively. Postoperative hemodynamics were similar for both groups. The incidence of nausea and vomiting was slightly more frequent in the morphine group, but the occurrence of confusion did not differ between groups. In conclusion, SNB provides a quality of transitional analgesia that is similar to that of morphine with the same postoperative hemodynamic profile.

Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial

“…14,15 In the present study, we did not obtain higher NRS scores compared with our similarly designed previous study in the supratentorial population. 6 However, the need for analgesia in the postoperative period was much greater in the present study than in our previous study (553 mg ± 400 vs 332 mg ± 230, respectively; P = 0.009). In a prospective study, Gottschalk et al…”

“…They reported that those who underwent infratentorial procedures had more severe pain and received greater quantities of opioid and non-opioid analgesics than those who underwent supratentorial procedures. In contrast, in their study in 2003, Irefin et al 6 found median pain scores of 2 in supratentorial craniotomy and spine patients vs median pain scores of 5 in patients with infratentorial craniotomy, but the results did not reach statistical significance (P = 0.06). This difference in the amount of pain might be due more to the extent of muscle damage in the operative approach than due to the craniotomy site per se.…”

“…Two studies examined the potential benefits of regional anesthesia in patients undergoing intracranial procedures with a remifentanil-based anesthesia. 6,12 Both studies showed that scalp nerve block was equivalent to morphine for transitional analgesia after supratentorial procedures. Infratentorial procedures were not included in these studies.…”

“…In this setting, scalp nerve block has been shown to be a good alternative to opioids. [5][6][7][8][9][10][11][12] The focus of these studies was on the evaluation of pain in supratentorial surgery, whereas patients undergoing infratentorial or occipital neurosurgery report more severe pain with increased opioid consumption. [13][14][15][16] The superficial cervical plexus block (SCPB) blocks the branches of the occipital nerves and may be a good alternative to opioid analgesia in this patient population.…”

Scalp Block for Burr Holle Evacuation of Subdural Hematoma: A Series of Seven Patients and Review of the Literature

“…The median pain score at the postoperative sixth hour was shown to be significantly lower after bupivacaine application. In a recent randomized, controlled and double-blind study that compared morphine administration and scalp block, similar efficiency has been reported for both methods; however, morphine administration was associated with higher incidence of nausea and vomiting [24]. Despite the advantages that have been reported so far [6][7][8][9], the use of local anesthetics in these procedures produces the risk of all complications related to local anesthetic agents.…”