Local anesthetics for brain tumor resection: current perspectives

Abstract

This review summarizes the added value of local anesthetics in patients undergoing craniotomy for brain tumor resection, which is a procedure that is carried out frequently in neurosurgical practice. The procedure can be carried out under general anesthesia, sedation with local anesthesia or under local anesthesia only. Literature shows a large variation in the postoperative pain intensity ranging from no postoperative analgesia requirement in two-thirds of the patients up to a rate of 96% of the patients suffering from severe postoperative pain. The only identified causative factor predicting higher postoperative pain scores is infratentorial surgery. Postoperative analgesia can be achieved with multimodal pain management where local anesthesia is associated with lower postoperative pain intensity, reduction in opioid requirement and prevention of development of chronic pain. In awake craniotomy patients, sufficient local anesthesia is a cornerstone of the procedure. An awake craniotomy and brain tumor resection can be carried out completely under local anesthesia only. However, the use of sedative drugs is common to improve patient comfort during craniotomy and closure. Local anesthesia for craniotomy can be performed by directly blocking the six different nerves that provide the sensory innervation of the scalp, or by local infiltration of the surgical site and the placement of the pins of the Mayfield clamp. Direct nerve block has potential complications and pitfalls and is technically more challenging, but mostly requires lower total doses of the local anesthetics than the doses required in surgical-site infiltration. Due to a lack of comparative studies, there is no evidence showing superiority of one technique versus the other. Besides the use of other local anesthetics for analgesia, intravenous lidocaine administration has proven to be a safe and effective method in the prevention of coughing during emergence from general anesthesia and extubation, which is especially appreciated after brain tumor resection.

Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

“…Postoperative pain control in neurosurgery should keep the balance between providing the best conditions for neurological assessment (e.g. preventing sedation) on one side and providing patient comfort on the other side [3]. The use of a local anesthetic scalp block was found to provide postoperative pain control following craniotomyin in the early postoperative period [40,41], which comes in accordance with the results obtained in the present study.…”

“…Awake craniotomy can be defined as a sort of craniotomy in which the patient is conscious and responsive at any time during the procedure [3]. It might be performed under one of three different forms of anesthetic care.…”

“…Local anesthesia is the cornerstone in awake craniotomy surgeries [5][6][7]. In awake allthrough technique, effective local anesthetics is mandatory [3].…”

Scalp block untuk Kraniotomi dan Penanganan Nyeri Membandel Pasca Kraniotomi

“…Scalp block juga dapat dipergunakan untuk pembedahan lain dikepala pada kasus kasus dermatologi termasuk keratosis, karsinoma dan juga kranioplasty. 2,4 Hal yang penting pada scalp block adalah blok serabut saraf oksipital mayor atau great oksipital nerve (GON). Teknik ini telah digunakan di klinik sakit kepala selama beberapa dekade untuk menangani pasien dengan neuralgia oksipital, migrain, cluster headache, dan sakit kepala pascakontusio.…”

Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial

“…The skin incision is the main source of pain during craniotomy. Scalp nerve block has been proven to be an excellent alternative analgesic choice in supratentorial surgeries 9–11. However, for the suboccipital retrosigmoid craniotomy, the scalp innervation area is insufficient to cover the incision, resulting defective nerve blockage.…”