A Comparison of Effects of Scalp Nerve Block and Local Anesthetic Infiltration on the Inflammatory Response, Hemodynamic Response, and Postoperative Pain in Patients undergoing Craniotomy for Cerebral Aneurysms: A Randomized Controlled Trial

Abstract

BACKGROUND: The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic infiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic response, and postoperative pain control in patients undergoing craniotomy. METHODS: Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm. They were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15 mL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine levels in plasma for 72 hrs postoperatively, hemodynamic response to skin incision, and postoperative pain intensity were measured. RESULTS:The SNB with 0.75% ropivacaine not only decreased IL-6 levels in plasma 6 hrs after craniotomy but also decreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 hrs after surgery compared to LA and routine analgesia. There were significant increases in mean arterial pressure 2 and 5 mins after the incision and during dura opening in Groups I and C compared with Group S. Group S had lower postoperative pain intensity, longer duration before the first dose of oxycodone, less consumption of oxycodone and lower incidence of PONV through 48 hrs postoperatively than Groups I and C. CONCLUSION: Preoperative SNB attenuated inflammatory response to craniotomy for cerebral aneurysms, blunted the hemodynamic response to scalp incision, and controlled postoperative pain better than LA or routine analgesia.

Effects of Scalp Nerve Block on the Quality of Recovery after Minicraniotomy for Clipping of Unruptured Intracranial Aneurysms : A Randomized Controlled Trial

“…Contrary to previous findings that SNB could help reduce PONV by reducing opioid consumption, the incidence and severity of PONV in this study were comparable between the SNB and control groups despite significantly more IV-PCA consumption up to 3 hours postoperatively in the control group 17,41) . This could be explained by significantly longer surgical duration in the SNB group with a mean difference of 30 minutes compared to the control group.…”

“…Therefore, scalp nerve block (SNB) has been increasingly used as an effective alternative to systemic administration of opioids in PCH. SNB is known to effectively reduce PCH, opioid consumption, inflammation, and postoperative nausea and vomiting (PONV) in conventional craniotomy patients 1,2,17,41,42,45) .…”