A comparison of effects of scalp nerve block and local anesthetic infiltration on 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 h 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 h after craniotomy but also decreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 h 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 h 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. Trial registration Clinicaltrials.gov NCT03073889 (PI:Xi Yang; date of registration:08/03/2017).

Postoperative Regional Scalp Block versus Intravenous Fentanyl for Postsupratentorial Craniotomy Analgesia in Adult Patients under General Anesthesia

“…We found in our study that postoperative hypertension and tachycardia (increase in MAP and HR) in response to craniotomy were signi icantly atten-uated for long duration during the postoperative period in group B compared to group C where there was a more prominent hyperdynamic response. Our results were in agreement with the research introduced by Yang et al (2019). In which the hemodynamic response and postoperative pain were assessed after regional scalp block in patients performing craniotomy for the repair of cerebral arteriovenous malformations, but it was different from our study in terms of that the local anaesthetic used was ropivacaine instead of lidocaine/bupivacaine mixture in our study.…”

“…Lidocaine 2% / bupivacaine 0.5% 1:1mixture and epinephrine 1/200000 has been used in our study instead of lidocaine alone; that was used in the research introduced by Yang et al (2019); to avoid the occurrence of local anaesthetic toxicity and prolong the duration of analgesia.…”

"RETRACTED ARTICLE:Successful implementation of an enhanced recovery after surgery (ERAS) protocol reduces nausea and vomiting after infratentorial craniotomy for tumour resection: a randomized controlled trial

“…It is possible that the lower incidence of PONV in the ERAS group was related to less intraoperative remifentanil consumption and postoperative analgesics use. This may be another reason for improving PONV [37]. In addition, multivariate analysis revealed that preoperative mouth-rinsing (Compound Chlorhexidine Gargle) and PONV prophylaxis were independent predictors for a lower incidence of vomiting on POD 2 in all patients ( Table 6).…”

Enhanced Recovery After Surgery – ERAS in Elective Craniotomies-a Non-randomized Controlled Trial

“…The practice points for instituting a protocol for and the bene ts Scalp blocks provide better attenuation of in ammatory and hemodynamic response to craniotomyand better postoperative analgesia than incision site in ltration with local anesthetics (LA). (18) This, along with the addition of upiritine, a centrally-actingnonopioid analgesic, with selective action on neuronal potassium channels (Kv7), resulted in signi cantly improved post-surgical VAS cored in GrE. Flupiritine has been used previously in patients undergoing craniotomy to reduce pain and anxiety perioperatively.…”