Scalp Infiltration with Bupivacaine Plus Epinephrine or Plain Ropivacaine Reduces Postoperative Pain After Supratentorial Craniotomy

Abstract

Local anesthetic infiltration has been proposed to decrease postoperative pain. The aim of this study was to determine whether scalp infiltration with bupivacaine or ropivacaine would improve analgesia after supratentorial craniotomy for tumor resection. Eighty patients were recruited into a randomized double-blind study. Infiltration was performed after skin closure with 20 mL of saline 0.9% (placebo group, n = 40), of 0.375% bupivacaine with epinephrine 1:200,000 (bupivacaine group, n = 20), or of 0.75% ropivacaine (ropivacaine group, n = 20). Postoperative analgesia was provided with patient-controlled morphine IV analgesia (PCA). The study was continued until PACU discharge, which occurred early in the morning following surgery. Results are reported on 37 patients in the placebo group, 20 in the bupivacaine group, and 19 in the ropivacaine group because 4 patients experienced postoperative complications and were excluded from the study. Morphine titration at arrival in the postanesthesia care unit was necessary more often in the placebo group (62% of the patients) than in the 2 treated groups (19% in each, P = 0.02). The median quantity of morphine administered during the first 2 postoperative hours, including initial titration administered by a nurse and PCA-administered morphine, was lower in each treated group than in the placebo group (P < 0.01). The median morphine consumption up to the 16th postoperative hour was not significantly different among the 3 groups. There was no difference in the visual analogue scale scores among the 3 groups at any time. Scalp infiltration with either bupivacaine or ropivacaine had a statistically significant effect on morphine consumption during the first 2 postoperative hours.

Efficacy of intravenous patient-controlled analgesia after supratentorial intracranial surgery: a prospective randomized controlled trial

“…Although only a few studies have been performed evaluating PCA therapy in the management of postcraniotomy pain, 13,15,26,28,30 we believe that this is the first randomized controlled trial di rectly comparing standard intravenous PCA fentanyl with PRN therapy in this patient population. Furthermore, the use of intravenous PCA in this study neither altered the neurological examination nor increased the incidence of neurological deterioration.…”

Pain Assessment in Brain Tumor Patients after Elective Craniotomy

“…It is widely believed that patients do not experience intense pain following intracranial surgery due to the fact that surgical treatment of the brain parenchyma is not painful. However, it is common practice to infiltrate the scalp with lidocaine plus epinephrine to reduce postoperative pain after craniotomy [9]. A reasonable goal is to achieve relief of the patients' symptoms such as headache and neurologic deficits as well as postoperative pain following brain tumor surgery.…”

Technique of localizing the central sulcus under awaking anesthesia for treatmeat of gliomas in/or near motor areas

“…Resection of tumors near the central sulcus and with a deep location has been the neurosurgeon's eternal hydra in the surgical treatment of glioma (5,11). Intraoperative awakening with central sulcus localization can design a cortex surgical approach ( Figure 3A-I tensor imaging technology, and the three-dimensional shape structure of the white matter tracts to the T2-weighted image graph can clearly display the position of the tumor and guide the relatively safe resection of the tumor (6). In this group of patients, cerebral magnetic resonance diffusion tensor imaging and brain functional MRI were performed in patients with preoperative imaging that showed tumors dispersed or deep in the white matter.…”

“…Intraoperative incision is the main source of pain during the awake state. Using ropivacaine for nerve block, incision infiltration not only achieves good analgesic effect and lower toxicity, but the long duration could also have short-term analgesic effects after the surgery (6). The local anesthetic formulations of Qilu Hospital of Shandong University consist of 20 mL of 2% lidocaine, 10 mL of 75 mg ropivacaine, 0.5 mg of epinephrine, and 30 mL of physiological saline.…”