Ultrasound-guided superficial cervical plexus block reduces opioid consumption in patients undergoing craniotomy via suboccipital retrosigmoid approach: a randomized controlled trial

Abstract

IntroductionThe effectiveness of superficial cervical plexus block (SCPB) at decreasing opioid use and improving hemodynamic stability during suboccipital retrosigmoid craniotomy has not been established. The aim of this study is to evaluate the analgesic effect of preoperative ultrasound-guided SCPB for craniotomy via a suboccipital retrosigmoid approach.MethodsThis was a prospective, single-center, randomized, double-blind, parallel-group controlled trial. One hundred and six adult patients undergoing suboccipital retrosigmoid craniotomy were randomly allocated into either the SCPB group (n=53) to receive 10 mL of 0.5% ropivacaine or the control group (n=53) to receive 0.9% normal saline injected into the superficial layer of prevertebral fascia guided by ultrasound. The primary outcome was the cumulative consumption of sufentanil with patient-controlled intravenous analgesia (PCIA) within 24 hours. Secondary outcomes included the overall perioperative consumption of opioids, the area under the curve of the pain score from 1 hour to 48 hours (AUC1–48), intraoperative hemodynamic parameters, and anesthesia depth.ResultsThe mean PCIA pump cumulative consumption of sufentanil in the first 24 hour postoperative period was significantly lowered by SCPB (5.0 µg vs 9.8 µg, 95% CI: −8.0 to –2.4; p=0.001). The total perioperative consumption of sufentanil (45.0 µg vs 54.5 µg, 95% CI: –14.8 to –4.1; p=0.001) was also significantly decreased by SCPB. The incidence of severe pain within 24 hours was decreased by SCPB (7.5% vs 26.4%, p=0.01). SCPB significantly decreased the AUC1–48 of the pain score. Intraoperative hemodynamic parameters and anesthesia depth were similar between groups (p>0.05).DiscussionSCPB provides effective analgesia in patients undergoing craniotomy and tumor resection via suboccipital retrosigmoid approach. SCPB demonstrates an opioid-sparing effect and allows for the maintenance hemodynamic stability at an appropriate depth of anesthesia.Trial registration numberNCT04036812.

Peripheral regional anaesthesia and outcomes: a narrative review of the literature from 2013 to 2023

“…Out of these 10 studies, improvement in the quality of recovery, as measured by the Quality of Recovery (QoR) questionnaire, was observed in three studies. 101 , 105 , 107 Perioperative opioid consumption was reduced in four studies, 96 , 100 , 103 , 108 pain levels reduced in two studies, 102 , 104 and a shorter time to discharge was observed in one study, 106 all in favour of patients who received a cervical plexus block compared with those who received systemic analgesia only.…”

“…Until 2013, cervical plexus block was mainly studied in relation to thyroid surgery (nine studies). Although thyroid surgery still remains the most extensively studied indication for cervical plexus block with nine RCTs ( n =612), 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 other types of surgery, including middle ear surgery, 102 , 103 parathyroidectomy, 104 , 105 carotid endarterectomy, 106 cervical discectomy and fusion, 107 and craniotomy 108 have also been described.…”

“…The majority of cervical plexus nerve blocks were performed using ultrasound guidance (nine studies), 96 , 98 , 99 , 101 , 102 , 103 , 104 , 105 , 108 whereas six studies used a landmark-based technique, 93 , 95 , 97 , 100 , 106 , 107 and one study did not report the specific method of needle guidance. 94 …”

“… 101 The incidence of PONV was reduced in two studies, 95 , 101 with a similar incidence between groups in three studies. 93 , 99 , 108 Because of the small sample sizes and low incidence of PONV, it was not possible to draw conclusions regarding differences between the groups.…”

Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence

“…In a single-center, double-blinded RCT of 30 patients undergoing infratentorial or occipital craniotomy, Girard et al 76 reported that postsurgical landmark-based SCPB provided comparable postoperative analgesia to an intravenous opioid technique. A recent RCT of 106 patients undergoing suboccipital retrosigmoid craniotomy by Zeng et al 77 similarly reported reduced 24-hour opioid consumption and reduced incidence of severe postoperative pain among patients who received presurgical, ultrasound-guided SCPB as compared with those who received a sham block.…”