Scalp blocks for brain tumor craniotomies: A retrospective survival analysis of a propensity match cohort of patients

Cata, Juan P.; Bhavsar, Shreyas; Hagan, Katherine; Arunkumar, Radha; Grasu, Roxana; Dang, Anh; Carlson, Richard; Arnold, Benjamin; Popat, Keyuri; Potylchansky, Y.; Lipski, Ian; Raty, Sally; Nguyen, Anh T.; McHugh, Thomas M.; Feng, Lei; Rahlfs, Thomas F.

doi:10.1016/j.jocn.2018.02.022

Cited by 17 publications

(9 citation statements)

References 20 publications

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“…Accordingly, scalp infiltration with ropivacaine or bupivacaine in the ERAS protocol may reduce the incidence and severity of postoperative pain, which has also been shown in other studies [32,44,45]. The mechanisms underlying the beneficial effects of local anesthetic blocks include a reduction in the inflammatory and stress response associated with surgery, lower levels of angiogenesis, a decrease in the requirements of volatile anesthetics and minimization or avoidance of opioid [46]. Thirdly, non-opioid analgesics including acetaminophen or non-steroidal anti-inflammatory drugs were administrated according to the pain degree of patient postoperative NRS scores.…”

Section: Discussionmentioning

confidence: 61%

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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Objective: To prospectively evaluate the efficacy of a neurosurgical enhanced recovery after surgery (ERAS) protocol on the management of postoperative pain after elective craniotomies. Methods: This randomized controlled trial was conducted in the neurosurgical center of Tangdu Hospital (Fourth Military Medical University, Xi'an, China). A total of 129 patients undergoing craniotomies between October 2016 and July 2017 were enrolled in a randomized clinical trial comparing an ERAS protocol to a conventional postoperative care regimen. The primary outcome was the postoperative pain score assessed by a verbal numerical rating scale (NRS). Results: Patients in the ERAS group had a significant reduction in their postoperative pain scores on POD 1 compared to patients in the control group (p < 0.05). More patients (n = 44, 68.8%) in the ERAS group experienced mild pain (NRS: 1 to 3) on POD1 compared with patients (n = 23, 35.4%) in the control group (p < 0.05). A further reduction in pain scores was also observed on POD 2 and maintained on POD 3 in the ERAS group compared with that in the control group. In addition, the median postoperative length of hospital stay was significantly decreased with the incorporation of the ERAS protocol compared to controls (ERAS: 4 days, control: 7 days, P<0.001). Conclusion: The implementation of a neurosurgical ERAS protocol for elective craniotomy patients has significant benefits in alleviating postoperative pain and enhancing recovery leading to early discharge after surgery compared to conventional care. Further evaluation of this protocol in larger, multi-center studies is warranted.

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Section: Discussionmentioning

confidence: 61%

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Qu¹,

Liu

Zhang³

et al. 2020

Int. J. Med. Sci.

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“…Regarding the influence of scalp block on postcraniotomy oncological outcomes, 2 recent studies by the same research group arrived at conflicting results. 16,17 Zheng et al 17 reported that, among 119 patients with gliomas, those with scalp block had longer PFS than those without. Our study findings are consistent with those of Zheng and colleagues despite that study including more patients with scalp block who underwent awake craniotomy; we excluded awake craniotomies from our analysis because awake surgery may be associated with more frequent total resections.…”

Section: Discussionmentioning

confidence: 99%

Scalp Block Is Associated With Improved Recurrence Profiles in Patients Undergoing Primary Glioma Resection Surgery

Sung¹,

Shih²,

Chang³

et al. 2019

Journal of Neurosurgical Anesthesiology

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Background: Glioma is associated with high recurrence and poor survival, despite the success of tumor resection surgery. This may be partly because the immune microenvironment within a glioma is susceptible to perioperative immunosuppression. Therefore, intraoperative anesthesia-related immunomodulators, such as scalp block, intravenous anesthesia, the opioid dosage administered, and transfusions, may influence oncological outcomes among patients with glioma. The aim of this retrospective study was to investigate the influence of anesthetic techniques on oncological outcomes after craniotomy for glioma resection, particularly the effects of scalp block, intravenous anesthesia, and inhalation anesthesia.Methods: Consecutive patients who underwent primary glioma resection surgeries between January 2010 and December 2017 were analyzed to compare postcraniotomy oncological outcomes (progression-free survival [PFS] and overall survival) by using the Kaplan-Meier method and multivariate Cox regression analysis. A propensity score-matched regression analysis including prognostic covariates was also conducted to analyze the selected relevant anesthetic factors of the unmatched regression model.Results: A total of 230 patients were included in the final analysis. No analyzed anesthetic factor was associated with overall survival. Patients who received scalp block had a more favorable median (95% confidence interval [CI]) PFS (55.37 [95% CI,] mo; P = 0.0053). Scalp block was associated with improved PFS before (hazard ratio, 0.465; 95% CI, 0.272-0.794; P = 0.0050) and after (hazard ratio, 0.367; 95% CI, 0.173-0.779; P = 0.0091) propensity scorematched Cox regression analysis. By contrast, intravenous anesthesia, amount of opioid consumed, and transfusion were not associated with PFS. Conclusions:The study results suggest that the scalp block improves the recurrence profiles of patients receiving primary glioma resection.

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“…In contrast, other studies reported that epidural anesthesia associated with improved overall survival or recurrencefree survival following surgery for gastroesophageal, colorectal [70,71], prostate cancer [72][73][74], ovarian cancer [64], and for liver metastasis resection [75]. Progression-free survival was improved when a scalp block was added to general anesthesia for glioma resection [76].…”

Section: Clinical Outcomesmentioning

confidence: 92%

Anesthetic technique and cancer surgery outcomes

Dubowitz

Hiller

Riedel

2021

Current Opinion in Anaesthesiology

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Purpose of reviewSurgery remains integral to treating solid cancers. However, the surgical stress response, characterized by physiologic perturbation of the adrenergic, inflammatory, and immune systems, may promote procancerous pathways. Anesthetic technique per se may attenuate/enhance these pathways and thereby could be implicated in long-term cancer outcomes. Recent findingsTo date, clinical studies have predominantly been retrospective and underpowered and, thus limit meaningful conclusions. More recently, prospective studies of regional anesthesia for breast and colorectal cancer surgery have failed to demonstrate long-term cancer outcome benefit. However, based on the consistent observation of protumorigenic effects of surgical stress and that of volatile anesthesia in preclinical studies, supported by in vivo models of tumor progression and metastasis, we await robust prospective clinical studies exploring the role of propofol-based total intravenous anesthesia (cf. inhalational volatiles). Additionally, anti-adrenergic/anti-inflammatory adjuncts, such as lidocaine, nonsteroidal anti-inflammatory drugs and the anti-adrenergic propranolol warrant ongoing research.

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Scalp blocks for brain tumor craniotomies: A retrospective survival analysis of a propensity match cohort of patients

Cited by 17 publications

References 20 publications

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Management of Postoperative Pain after Elective Craniotomy: A Prospective Randomized Controlled Trial of a Neurosurgical Enhanced Recovery after Surgery (ERAS) Program

Scalp Block Is Associated With Improved Recurrence Profiles in Patients Undergoing Primary Glioma Resection Surgery

Anesthetic technique and cancer surgery outcomes

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