Effect of Scalp Block on Postoperative Pain Relief in Craniotomy Patients

Abstract

The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol IV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P<0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P<0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.

Addition of midazolam to continuous postoperative epidural bupivacaine infusion reduces requirement for rescue analgesia in children undergoing upper abdominal and flank surgery

“…The number of doses of each rescue analgesic agent received per patient (frequency) was noted, as was the time to first administration of rescue analgesia. Sedation was assessed using a 4-point sedation score [Appendix B] [13]. Motor power was assessed by modified Bromage Score [Appendix C] [14].…”

Anatomy of the greater occipital nerve block in infants

“…It travels deep to the semispinalis capitis muscle, after which it pierces this muscle and emerges onto the scalp by passing above an aponeurotic sling that is located between the trapezius and sternocleidomastoid muscles. It is closely accompanied by the occipital artery, which lies lateral to the nerve as it emerges onto the posterior scalp …”

“…It is closely accompanied by the occipital artery, which lies lateral to the nerve as it emerges onto the posterior scalp. 10 In adults, one of the most common landmarks used for blocking the greater occipital nerve is a point at the medial one-third of the line drawn between the external occipital protuberance and the mastoid process or by palpating the occipital artery, which lies lateral to the nerve. 11 Suresh and Voronov suggested that in children, the midpoint of a line drawn between the mastoid process and the midline, is a good guide to the location of the greater occipital nerve.…”

11 Principles of Anesthesia in Skull Base Surgery

“…6 • Following removal of the tumor, generally normocarbia (Pco 2 [35][36][37][38][39][40] is used to enable a return of normal cerebral circulation, to identify areas of poor hemostasis, and to enable normal brain to gradually reexpand into the surgical cavity.…”