Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series

Patel, Kunal; Sun, Matthew Z.; Willis, Shelby; Alemnew, Mahlet; Jong, Russell De; Evans, Audree; Duong, Courtney; Gopen, Quinton; Yang, Isaac

doi:10.1016/j.jocn.2021.09.010

Cited by 5 publications

(6 citation statements)

References 32 publications

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“…A large portion of our patients had no pain or well-controlled pain in the immediate and initial period after surgery, with pain scores rising thereafter. Our results are consistent with Nassar et al and two other studies conducted in adults, in which pain scores were significantly lower than control at the first 4 h period post-craniotomy [ 5 , 17 , 18 ]. The advantages of greater occipital nerve blockade include ease and safety of the technique, speed of performance (typically 5 to 10 min for bilateral blockade in our experience), and the ability to perform the block in the same position and field as the surgery.…”

Section: Discussionsupporting

confidence: 93%

Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series

et al. 2023

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Various regional anesthetics have been used for postoperative analgesia for pediatric craniotomy. In this case series, we report retrospectively collected data on postoperative pain and analgesic use in 44 patients who received ultrasound-guided occipital nerve blocks in addition to intravenous analgesic agents for posterior craniotomy procedures. In the immediate post-anesthesia care unit, pain was rated as zero or well controlled in 77% of patients, with only 43% requiring intravenous or demand patient-controlled analgesia opioids. There were no block-related complications. Occipital nerve blocks may constitute a safe and effective component of multimodal analgesia in this population.

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Section: Discussionsupporting

confidence: 93%

Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series

et al. 2023

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“…When the body suffers trauma, the hypothalamic-pituitary-adrenocortical axis is excited and secretes a large amount of glucocorticoids, progressively increasing the plasma cortisol and blood glucose [ 9 ]. Our results showed that the blood glucose level in Group N was significantly higher than that in Group A at 1 h after the operation, indicating that scalp nerve block suppressed pain, reduced stress and inhibited the increase in blood glucose [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided scalp nerve block in anesthesia of children receiving cranial suture reconstruction

Zou

Ding

et al. 2023

BMC Anesthesiol

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Objective Analgesia is very important for children with craniosynostosis who are undergoing cranial suture reconstruction. This study investigated the effectiveness and safety of an analgesic technique based on scalp nerve block combined with general anesthesia versus general anesthesia alone. Methods This was a single-center, prospective, randomized, controlled study. A total of 60 children aged 6-24 months who underwent cranial suture reconstruction were randomly divided into two groups: Group A (general anesthesia combined with scalp nerve block) and Group N (general anesthesia). The hemodynamics were recorded preoperatively, at 5 min after incision and at 1, 6 and 12 h after surgery; the pain was scored at 1, 6 and 12 h after surgery, and blood glucose was detected at 1 h after surgery. Results The mean arterial pressure and heart rate at 5 min after incision and 1 h after surgery in Group N were higher than those in Group A; the blood glucose and FLACC score in Group N were higher than those in Group A; and the number of postoperative analgesic pump presses were also significantly increased in Group N. Conclusion Preoperative scalp nerve block can reduce hemodynamic fluctuation and postoperative pain in children undergoing cranial suture reconstruction for craniosynostosis. Thus, it can be safely and effectively applied in the anesthesia of these children.

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“…Previous studies have also observed that a scalp block decreases pain scores for up to 12 h after surgery, and although an overall reduction in the opioid requirements has been observed, the studies have shown some heterogeneity [ 15 , 26 ]. We acknowledge that the question may rise regarding the justification for our hypothesis targeting only the first 24 h after surgery and not a longer duration.…”

Section: Discussionmentioning

confidence: 99%

“…No nerve-block-related or anesthesia-related complications occurred in any of the participants during hospital stay. Excluding the one patient in the block group who required prolonged intubation, the median and interquartile range of extubation time from the end of surgery was 35 (26,42) minutes in the control group and 29 (23,40) minutes in the block group (p-value = 0.185). One patient who underwent prolonged intubation for 1160 min experienced intraoperative bleeding, necessitating sedation on the day of surgery.…”

Section: Study Participantsmentioning

confidence: 99%

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

Lee,

Kwon

et al. 2023

JCM

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The scalp nerve block, created by injecting local anesthetics around the scalp nerves, is reported to effectively reduce pain after surgery. In this study, we evaluated the efficacy of scalp nerve block in patients with hemifacial spasm (HFS) undergoing microvascular decompression (MVD). Seventy-four patients who underwent MVD for HFS were enrolled. The block group received scalp nerve block with 0.5% ropivacaine before surgery. The primary outcome was cumulative dose of rescue analgesics 24 h postoperatively. The secondary outcomes were included pain scores, postoperative antiemetic consumption, and Quality of Recovery-15 scale. The cumulative dose of rescue analgesics at 24 h postoperatively was not significantly different between the two groups (4.80 ± 3.64 mg vs. 5.92 ± 3.95 mg, p = 0.633). However, the pain score was significantly reduced in the block group at 6, 12, and 24 h postoperatively. Postoperative antiemetic consumption was lower in the block group than the control group at 12 h. There were no significant differences between the two groups for other secondary outcomes. In MVD for HFS, a preoperative scalp nerve block might reduce postoperative pain in the early postoperative period, but a larger study using a multimodal approach is needed to confirm the efficacy of a scalp block.

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Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series

Cited by 5 publications

References 32 publications

Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series

Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series

Ultrasound-guided scalp nerve block in anesthesia of children receiving cranial suture reconstruction

The Efficacy of Scalp Nerve Block in Postoperative Pain Management after Microvascular Decompression: A Randomized Clinical Trial

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