Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial

Li, Ning; Jiang, Lai; Zhang, Qingqing; Luo, Mingbiao; Xu, Daojie; Peng, Yuanzhi

doi:10.3389/fmed.2022.952064

Cited by 7 publications

(8 citation statements)

References 40 publications

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“…Fifty-one full texts were assessed for eligibility in this meta-analysis. Three studies were excluded since they analyzed the effects of preventive treatment for post-craniotomy pain in the pediatric population [ 39 , 40 , 41 ]. Eight studies were excluded because they were determined to be observational studies [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ].…”

Section: Resultsmentioning

confidence: 99%

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

et al. 2023

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Background and Objective: To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. Material and Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated the effectiveness of pharmacological treatments for preventing post-operative pain in adults (aged 18 years or older) undergoing craniotomies. The main outcome measures were represented by the mean differences in validated pain intensity scales administered at 6 h, 12 h, 24 h and 48 h post-operatively. The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the RoB2 revised tool, and the certainty of evidence was assessed according to the GRADE guidelines. Results: In total, 3359 records were identified through databases and registers’ searching. After study selection, 29 studies and 2376 patients were included in the meta-analysis. The overall risk of bias was low in 78.5% of the studies included. The pooled estimates of the following drug classes were provided: NSAIDs, acetaminophen, local anesthetics and steroids for scalp infiltration and scalp block, gabapentinoids and agonists of adrenal receptors. Conclusions: High-certainty evidence suggests that NSAIDs and acetaminophen may have a moderate effect on reducing post-craniotomy pain 24 h after surgery compared to control and that ropivacaine scalp block may have a bigger impact on reducing post-craniotomy pain 6 h after surgery compared to control. Moderate-certainty evidence indicates that NSAIDs may have a more remarkable effect on reducing post-craniotomy pain 12 h after surgery compared to control. No moderate-to-high-certainty evidence indicates effective treatments for post-craniotomy pain prevention 48 h after surgery.

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Section: Resultsmentioning

confidence: 99%

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

et al. 2023

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“…Two protocols registered with the Chinese Clinical Trial Registry suggest studies may begin shortly to investigate effects in children. 57,58…”

Section: Discussionmentioning

confidence: 99%

“…Two protocols registered with the Chinese Clinical Trial Registry suggest studies may begin shortly to investigate effects in children. 57,58 Studies commonly included only patients able to communicate VAS results, with an American Society of Anesthesiology grade of I-II or I-III (Supplemental Materials, Appendix C, http://links. lww.com/NEU/D625).…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy

et al. 2023

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BACKGROUND: Scalp block is regional anesthetic injection along nerves innervating the cranium. Scalp blocks for craniotomy may decrease postoperative pain and opioid consumption. Benefits may extend beyond the anesthetic period. OBJECTIVE:To analyze evidence for scalp block on postoperative pain and opioid use. METHODS: This systematic review and meta-analysis, Prospective Register of Systematic Reviews registration (CRD42022308048), included Ovid Medical Literature Analysis and Retrieval System Online, Embase, and Cochrane Central Register of Controlled Trials inception through February 9, 2022. Only randomized controlled trials were included. We excluded studies not reporting either main outcome. Duplicate reviewers performed study selection, risk of bias assessment, data extraction, and evidence certainty Grading of Recommendations Assessment, Development, and Evaluation appraisal. Main outcomes were postoperative pain by visual analog scale within 72 hours and opioid consumption as morphine milligram equivalent (MME) within 48 hours. RESULTS: Screening filtered 955 studies to 23 trials containing 1532 patients. Risk of bias was overall low. Scalp block reduced postoperative pain at 2 through 72 hours, visual analog scale mean differences of 0.79 to 1.40. Opioid requirements were reduced at 24 hours by 16.52 MME and 48 hours by 15.63 MME. CONCLUSION: Scalp block reduces postoperative pain at 2 through 48 hours and may reduce pain at 72 hours. Scalp block likely reduces opioid consumption within 24 hours and may reduce opioid consumption to 48 hours. The clinical utility of these differences should be interpreted within the context of modest absolute reductions, overall care optimization, and patient populations. This is the first level 1A evidence to evaluate scalp block efficacy in craniotomy.

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“…Festa et al [36] reported that scalp block provides better pain control and limits the need for rescue analgesia when compared with conventional treatment in craniosynostosis surgery in patients under two years of age. Also, Ning et al [37] showed that scalp block is associated with better postoperative pain control and intra-operative hemodynamic stability in comparison with the control group in pediatric craniotomy cases. Unfortunately, post-operative pain evaluation is not available in the presented study, so similar multimodal analgesia strategies based on studies in the literature were performed.…”

Section: Discussionmentioning

confidence: 99%

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

et al. 2023

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Background/Aim: Pediatric neuroanesthesia is a special field that requires significant experience and infrastructure because of anatomical, neurological, and pharmacological differences in the pediatric patient population. Although technological improvements provide more effective and safer neuroanesthesiological management, the principles of neuroanesthesia, neurocognitive development, and the effects of anesthetic agents on central nervous system development are well-known. The majority of pediatric neuroanesthesia articles in the literature are reviews; however, retrospective/prospective case series and controlled research are limited. In this retrospective cohort study, we aimed to contribute to the existing literature by reviewing and analyzing our single-center 10-year experiences and results addressing pediatric neuroanesthesia management. Methods: After ethical committee approval, anesthetic and surgical reports from 1165 pediatric neurosurgical cases over ten years were collected. Demographic data, intra-operative vascular management, anesthesia techniques, airway management, patient positions, analgesia methods, and complications were evaluated in this retrospective cohort study. The available surgical intervention, patient positions, intra-operative neuromonitorization (IONM), and intra-operative magnetic resonance imaging (IOMR) records were also analyzed. Results: Six-hundred forty-six (55.4%) girls and 519 (44.5%) boys were included in the study. The median age was 60 (0–216) months. Cranial interventions were performed in 842 (72.3%) patients, and spinal interventions were performed in 323 (27.7%) patients. Patients’ American Society of Anesthesiologists (ASA) physical scales grouped as I, II, III, and IV were 718 (61.6%), 360 (30.9%), 82 (7%), and 5 (0.4%), respectively. Sevoflurane (40.3%), propofol (37.2%), and sodium thiopental (2.5%) were used for anesthetic induction. Neuromuscular block was performed with rocuronium (56.7%) and atracurium (14.4%). Neuromuscular blocking agents were not used in 337 patients (28.9%). A blood transfusion was required in 120 patients (10.3%), and 40% of these patients underwent surgery for craniosynostosis. Two-hundred twenty-two (19.1%) were monitored with IONM, and IOMR was carried out in 124 (10.6%) of the cases. The anesthesia-related complication rate was 5.15% (60 patients). Conclusion: Although pediatric neurosurgical interventions involve high risks, they are becoming increasingly common in our daily practice. Neuroanesthesiologists should know the procedures, techniques, and advances for safe and effective management of pediatric neurosurgical cases. We think that these data may be helpful as a guide for the anesthetic management of pediatric neurosurgical cases.

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Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial

Cited by 7 publications

References 40 publications

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy

Pediatric neuroanesthesia experiences: A single center retrospective cohort study

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