Preoperative Versus Postoperative Scalp Block Combined With Incision Line Infiltration for Pain Control After Supratentorial Craniotomy

Abstract

Objective: Postoperative pain after craniotomy is a significant clinical problem that is sometimes underestimated, although moderate or severe pain in early postoperative period complicates up to 60% of cases. The purpose of this prospective randomized multicenter trial was to determine the optimal timing for selective scalp block in patients undergoing general anesthesia for supratentorial craniotomy. Materials and Methods: After ethics committee approval and informed consent, 56 adult patients were enrolled, and randomly assigned to receive a selective scalp block combined with incision line infiltration preoperatively or postoperatively. Results: Postoperative pain at 24 hours after the procedure was recorded in all 56 enrolled patients. In patients assigned to receive a scalp block preoperatively, median VAS score at 24 hours after surgery was 0 (0 to 2), and in patients assigned to receive a scalp block postoperatively it was 0 (0 to 3) (P>0.05). There was no difference in severity of pain at 24, 12, 6, and 2 hours after surgery between the 2 study groups, but the amount of fentanyl administered intraoperatively was lower in patients assigned to the preoperative scalp block group (1.6±0.7 vs. 2.4±0.7 mkg/kg/h, P=0.01). Discussion: This study confirms and extends available clinical evidence on the safety and efficacy of selective scalp blocks for the prevention of postoperative pain. Recorded data suggest that there is no difference in terms of occurrence and severity of postoperative pain regardless of whether the scalp block is performed preoperatively (after general anesthesia induction) or postoperatively (before extubation). Patients assigned to receive a scalp block combined with incision line infiltration preoperatively needed less intraoperative opioids than those assigned to postoperative scalp block.

Effect of Scalp Nerve Block Combined with Intercostal Nerve Block on the Quality of Recovery in Patients with Parkinson’s Disease after Deep Brain Stimulation: Protocol for a Randomized Controlled Trial

“…Our preliminary study has found that more than 70% of patients experienced moderate-to-severe pain after DBS, similar to previous studies [ 14 , 15 , 16 ]. However, long-term postoperative pain affects the quality of recovery in PD patients, which will increase complications and prolong hospital stays.…”

“…A previous study has shown that analgesic methods were administrated less frequently for neurosurgery than other operations [ 13 ], and clinicians often fail to provide early sufficient postoperative analgesia due to the early assessment of consciousness. Recent studies have shown that up to 80% of patients suffered moderate-to-severe pain following neurosurgery [ 14 , 15 , 16 ]. So far, few studies have explored effective analgesic methods for DBS surgery.…”

Regional scalp block – the key analgesic element of anesthesia for supratentorial craniotomy

“…Наконец, последнее по времени наше исследование в данной области было нацелено на выявление оптимального времени выполнения скальп-блока для эффективного послеоперационного обезболивания. На основе группы из 56 пациентов нам удалось показать, что использование регионарной анестезии скальпа до разреза не уступает по эффективности послеоперационного обезболивания группе, в которой скальп-блок был выполнен после окончания операции [19]. Оба подхода предотвратили развитие сильной боли после супратенториальной краниотомии в первые сут, однако, в случае выполнения блокады до разреза, существенно снижался расход фентанила по ходу вмешательства, что и определяет преимущество данного подхода.…”

Scalp block for postoperative pain after craniotomy: A meta-analysis of randomized control trials

“…Analgesia could be achieved by blockade of the following nerves: greater and lesser occipital nerves, the supraorbital and supratrochlear nerves, the zygomaticotemporal nerve, the auriculotemporal nerve, and the greater auricular nerve ( 16 – 18 ). However, the strength of evidence supporting this practice was unclear and the best occasion of scalp block was also not identified ( 19 – 21 ). Therefore, we conducted a meta-analysis to evaluate the efficacy, safety, and the best occasion of scalp block for postoperative pain after craniotomy.…”