Pre- versus Postoperative Scalp Block Combined with Incision Line Infiltration for Pain Control after Supratentorial Craniotomy

Numerical Rating ◽

Fentanyl Consumption ◽

Background: Craniotomy causes acute and chronic pain. Uncontrolled postoperative pain may lead to adverse events. Perioperative scalp nerves block is not only effective in reducing intraoperative hemodynamic response, but it also reduces postoperative pain and postoperative analgesia requirement. Objective: To compare the benefits of adding dexmedetomidine to levobupivacaine in scalp nerves block before craniotomy for the duration of analgesia in supratentorial craniotomy. Materials and Methods: After approval by the Committee for Research, 50 supratentorial craniotomy patients were randomized into two groups. The control group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000, whereas the study group received 30 mL scalp nerves block with 0.25% levobupivacaine with adrenaline 1:200,000 plus dexmedetomidine 1 mcg/kg. The primary outcome was the time to first analgesic requirement postoperatively. The secondary outcomes included intraoperative fentanyl consumption, verbal numerical rating scale, tramadol consumption, and complications during the first 24 hours postoperatively. Results: Patients in the study group had significantly increase time to the first analgesic requirement in postoperative period and reduced intraoperative fentanyl consumption. The median time to first analgesic requirement was 555 (360 to 1,035) minutes in the study group versus 405 (300 to 520) minutes in the control group (p=0.023). Intraoperative fentanyl consumption 125 (75 to 175) mcg in the study group was significantly lower than 200 (150 to 250) mcg in the control group (p=0.02). The verbal numerical rating scale at 1, 4, 8, 12 and 24 hours postoperatively, tramadol consumption, and complications during the first 24 hours postoperatively were not statistically significant different. Conclusion: Preoperative scalp nerves block with 0.25% levobupivacaine with adrenaline (1:200,000) with dexmedetomidine 1 mcg/kg significantly increased the time to first analgesic requirement and reduced intraoperative fentanyl consumption compared to 0.25% levobupivacaine with adrenaline (1:200,000) without perioperative complications. Keywords: Scalp block, Dexmedetomidine, Post-craniotomy analgesia, Supratentorial tumor, Levobupivacaine

A49 An Audit of Post-operative Analgesia Requirements after a Supratentorial Craniotomy with and without an Intra-operative Scalp Block

European Journal of Anaesthesiology ◽

10.1097/01.eja.0000412495.74513.b7 ◽

2012 ◽

Vol 29 ◽

pp. S14-S15

Author(s):

C. Burnand ◽

J. Sebastian ◽

G. Sloan ◽

R. Vege

Keyword(s):

Regional scalp block – the key analgesic element of anesthesia for supratentorial craniotomy

Regional Anesthesia and Acute Pain Management ◽

10.17816/1993-6508-2021-15-2-119-126 ◽

2021 ◽

Vol 15 (2) ◽

pp. 119-126

Author(s):

Alexander S. Kulikov ◽

Valentina A. Tere ◽

Alexander A. Imaev ◽

Andrey Yu. Lubnin

Keyword(s):

Regional Anesthesia ◽

Personal Experience ◽

Routine Practice ◽

Block Method ◽

Perioperative Analgesia ◽

This paper presents the key data on the effectiveness and safety of the regional anesthesia of the scalp, also known as the scalp block, for providing perioperative analgesia for supratentorial craniotomy. The authors describe the technique and its limitations and also trace the implementation of the scalp block method into the routine practice of the largest Russian neurosurgical clinic based on personal experience, results of the own research, and analysis of literature data.

The scalp block for postoperative pain control in craniosynostosis surgery: a case control study

Child s Nervous System ◽

10.1007/s00381-020-04661-z ◽

2020 ◽

Vol 36 (12) ◽

pp. 3063-3070

Author(s):

Rossano Festa ◽

Federica Tosi ◽

Angela Pusateri ◽

Sonia Mensi ◽

Rossella Garra ◽

...

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Case Control Study ◽

Case Control ◽

Postoperative Pain Control ◽

Scalp Block ◽

Control Study

Preoperative regional scalp block versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3802 ◽

2020 ◽

Vol 11 (4) ◽

Author(s):

Ahmed Beniamen Mohamed Hussien ◽

ZakiTahaSaleh ◽

Hala Abdel Sadek Al attar ◽

Yasser Mohamed Nasr

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Stress Response ◽

General Anaesthesia ◽

Surgical Stress ◽

Control Group ◽

Surgical Stress Response ◽

Intravenous Fentanyl ◽

During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.