Effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on plasma and cerebrospinal fluid pro-inflammatory cytokine concentrations in patients with cerebral aneurysm: a randomized controlled trial

Abstract

Aim To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentrations in patients with non-ruptured brain aneurysms undergoing elective open surgery. Methods This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb between March 2019 and March 2020. At the beginning of anesthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-α, and IL-1β were measured before anesthesia (S0); at the incision (S1); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the incision (L1) and the end of surgery (L2). Results Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in lidocaine group, and at S2 and S3 in control group. In both groups, changes in TNF-α and IL-1β were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1β were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-α and IL-1β did not. No differences in clinical outcome and complication rates were observed. Conclusion Adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia might attenuate CSF IL-6 concentration increase in patients with brain aneurysm. Trial registration Clinical Trials NCT03823482

Association of scalp block with intraoperative hemodynamic profiles and postoperative pain outcomes at 24–48 hours following craniotomy: An updated systematic review and meta‐analysis of randomized controlled studies

“…Of the 502 records acquired from systematic search of the three databases (Figure 1), 12 were excluded for failing to meet the inclusion criteria. Finally, 12 RCTs involving 626 participants were included in the current meta‐analysis 19–30 . The characteristics of the included trials are shown in Table 1.…”

“…The mean age of the participants varied between 21 and 58 years. Eight trials included a placebo control group by conducting SB with saline (with or without epinephrine), 20–22,24,26–28,30 while SB was compared with IV remifentanil or no SB in the remaining four trials 19,23,25,29 . In three RCTs, SB was performed following completion of operation and skin closure, 20,24,26 whereas SB was administered before skin incision and craniotomy in the other nine trials 19,21–23,25,27–30 .…”

“…Finally, 12 RCTs involving 626 participants were included in the current meta-analysis. [19][20][21][22][23][24][25][26][27][28][29][30] The characteristics of the included trials are shown in Table 1. The population sizes of studies were small in all studies, ranging from 30 to 90.…”

“…Eight trials included a placebo control group by conducting SB with saline (with or without epinephrine) , [20][21][22]24,[26][27][28]30 while SB was compared with IV remifentanil or no SB in the remaining four trials. 19,23,25,29 In three RCTs, SB was performed following completion of operation and skin closure, 20,24,26 whereas SB was administered before skin incision and craniotomy in the other nine trials. 19,[21][22][23]25,[27][28][29][30] The local anesthetics used for SB included 0.5% or 0.75% ropivacaine (three trials), 26,29,30 0.5% bupivacaine (five trials), 19,21,23,27,28 2% lidocaine (one trial), 25 0.33% or 0.75% levobupivacaine (two trials), 22,24 and 0.5% bupivacaine combined with 2% lidocaine (one trial).…”

“…19,23,25,29 In three RCTs, SB was performed following completion of operation and skin closure, 20,24,26 whereas SB was administered before skin incision and craniotomy in the other nine trials. 19,[21][22][23]25,[27][28][29][30] The local anesthetics used for SB included 0.5% or 0.75% ropivacaine (three trials), 26,29,30 0.5% bupivacaine (five trials), 19,21,23,27,28 2% lidocaine (one trial), 25 0.33% or 0.75% levobupivacaine (two trials), 22,24 and 0.5% bupivacaine combined with 2% lidocaine (one trial). 20 Ten studies provided the surgical time varying from 156 to 438 min, [19][20][21][22][24][25][26][28][29][30] while two trials did not provide the details.…”