Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration

Akçıl, Eren Fatma; Dilmen, Özlem Korkmaz; Vehid, Hayriye Ertem; Ibısoglu, Lutfiye Serap; Tunalı, Yusuf

doi:10.1016/j.clineuro.2017.01.018

Cited by 49 publications

(74 citation statements)

References 27 publications

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“…Scalp infiltration does not reduce the need for postoperative pain medication. [ 2 7 12 71 ] A review by Hansen et al . [ 46 ] demonstrates that scalp infiltration can lead to a significant reduction in the pain scores, but only immediately or shortly after surgery is completed.…”

Section: Introductionmentioning

confidence: 99%

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Vacas¹,

Wiele²

2017

Surg Neurol Int

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Background:Craniotomy is a relatively common surgical procedure with a high incidence of postoperative pain. Development of standardized pain management and enhanced recovery after surgery (ERAS) protocols are necessary and crucial to optimize outcomes and patient satisfaction and reduce health care costs.Methods:This work is based upon a literature search of published manuscripts (between 1996 and 2017) from Pubmed, Cochrane Central Register, and Google Scholar. It seeks to both synthesize and review our current scientific understanding of postcraniotomy pain and its part in neurosurgical ERAS protocols.Results:Strategies to ameliorate craniotomy pain demand interventions during all phases of patient care: preoperative, intraoperative, and postoperative interventions. Pain management should begin in the perioperative period with risk assessment, patient education, and premedication. In the intraoperative period, modifications in anesthesia technique, choice of opioids, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), regional techniques, dexmedetomidine, ketamine, lidocaine, corticosteroids, and interdisciplinary communication are all strategies to consider and possibly deploy. Opioids remain the mainstay for pain relief, but patient-controlled analgesia, NSAIDs, standardization of pain management, bio/behavioral interventions, modification of head dressings as well as patient-centric management are useful opportunities that potentially improve patient care.Conclusions:Future research on mechanisms, predictors, treatments, and pain management pathways will help define the combinations of interventions that optimize pain outcomes.

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Section: Introductionmentioning

confidence: 99%

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Vacas¹,

Wiele²

2017

Surg Neurol Int

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“…Meanwhile, the interference on consciousness and postoperative neurological function should be minimised during the recovery and evaluation period. At present, PCIA with opioid is the most common analgesia modality for patients received craniotomy 21 22. However, undesirable effects of opioids, including respiratory depression, nausea, vomiting, urinary retention, etc, not only bring discomfort to patients, but also affect neurological function evaluation by neurosurgeons 23.…”

Section: Discussionmentioning

confidence: 99%

“…We estimate the sample size according to the primary outcome of postoperative-24-hour PCIA sufentanil consumption by using PASS 2011 software (NCSS LLC). Based on the previous literature,21 Akcil et al demonstrated the mean (95% CI) postoperative cumulative morphine consumption was 30 mg (25 to 35) in the scalp block group and 50 mg (40 to 60) in the control group. Considering that 1 mg morphine is equivalent to 1 µg sufentanil, we estimated the scalp block in their study reduced PCIA sufentanil consumption by 20 µg within postoperative 24 hours.…”

Section: Methodsmentioning

confidence: 98%

Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial

et al. 2020

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IntroductionScalp nerve block has been proven to be an alternative choice to opioids in multimodal analgesia. However, for the infratentorial space-occupying craniotomy, especially the suboccipital retrosigmoid craniotomy, scalp nerve block is insufficient.Methods and analysisThe study is a prospective, single-centre, randomised, paralleled-group controlled trial. Patients scheduled to receive elective suboccipital retrosigmoid craniotomy will be randomly assigned to the superficial cervical plexus block group or the control group. After anaesthesia induction, superficial cervical plexus nerve block will be performed under the guidance of ultrasound. The primary outcome is the cumulative consumption of sufentanil by the patient-controlled intravenous analgesia pump within 24 hours after surgery. Secondary outcomes include the cumulative consumption of sufentanil at other four time points and numerical rating scale pain severity score.Ethics and disseminationThe protocol (version number: 2.0, 10 April 2019) has been approved by the Ethics Review Committee of China Registered Clinical Trials (Ethics Review No. ChiECRCT-20190047). The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences.Trial registration numberNCT04036812

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“…MAP was lower in both groups than the control group at those periods of increased stimulation [ 2 ]. Additionally, in an interesting study, Akcil EF and colleagues investigated the effects of scalp block with 0.5% bupivacaine on haemodynamics and postoperative analgesic requirements in patients undergoing infratentorial craniotomies, they compared scalp block with local anaesthetic infiltration and a control group receiving remifentanyl, they found favorable effects on haemodynamics specially at the time of pinning in the scalp block group in comparison to the other 2 groups, the scalp block as well decreased the VAS in the early postoperative period and total opioid consumption in comparison to the control group [ 19 ]. The results support the outcome of the current study as hyaluronidase may have further potentiated the effect of scalp block resulting in a better control of hemodynamics during periods of increased stress.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

et al. 2018

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BackgroundPatients undergoing craniotomy operations are prone to various noxious stimuli, many strategies are commenced to provide state of analgesia, for better control of the stress response and to overcome its undesired effects on the haemodynamics and post-operative pain. Scalp nerves block are considered one of these strategies. This study was conceived to evaluate the effect of addition of hyaluronidase to the local anaesthetic mixture used in the scalp nerves block in patients undergoing elective craniotomy operations.Methods64 patients undergoing elective craniotomy operations were enrolled in this prospective randomized, double-blind comparative study. Patients were randomly assigned to two groups. Group LA, patients subjected to scalp nerves block with 15 ml bupivacaine 0.5%, 15 ml lidocaine 2%, in 1:400000 epinephrine. Group H as Group LA with15 IU /ml Hyaluronidase.ResultsPatients in the H group showed lower VAS values for 8 h postoperative, compared to the LA group. The haemodynamic response showed lower values in the H group, compared to the LA group. Those effects were shown in the intraoperative period and for 6 h post-operative. No difference was detected regarding the incidence of complications nor the safety profile.ConclusionOur data supports the idea that addition of hyaluronidase to the local anesthetic mixture improves the success rates of the scalp nerves block and its efficacy especially during stressful intraoperative periods and in the early postoperative period. No evident undesirable effects in relation to the addition of hyaluronidase.Trial registrationClinical Trial registry on ClinicalTrials.gov, NCT 03411330, 25-1-2018.

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Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration

Cited by 49 publications

References 27 publications

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices

Ultrasound-guided superficial cervical plexus block for analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach: study protocol of a randomised controlled trial

Safety and efficacy of addition of hyaluronidase to a mixture of lidocaine and bupivacaine in scalp nerves block in elective craniotomy operations; comparative study

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