Bala I, Gupta B, Bhardwaj N, Ghai B, Khosla V K
Department of Anaesthesiology and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Anaesth Intensive Care. 2006 Apr;34(2):224-7. doi: 10.1177/0310057X0603400203.
The efficacy of scalp nerve block using 0.5% bupivacaine with adrenaline for postoperative pain relief in craniotomy patients was evaluated in 40 ASA I or II adult patients undergoing supratentorial craniotomy. A standard general anaesthesia technique was followed. Patients were randomly divided into two groups. Group B received 0.5% bupivacaine with 1:400,000 adrenaline and group S received normal saline with 1:400,000 adrenaline, both after skin closure. Postoperative pain was assessed at 30 seconds and 1, 2, 4, 6, 8 and 12 hours using a numerical rating scale. Diclofenac IM was administered as rescue analgesia if patients reported a numerical rating scale of 40 or more. Tramadol IV was administered as second rescue analgesia. Sixty per cent of patients in group S experienced moderate to severe pain (numerical rating scale of 40 or more) at some time during the first 12 postoperative hours in comparison to 25% patients in group B. Median pain scores were significantly lower in group B for up to 6 hours. Significantly more patients were pain free up to four hours in group B. Median duration for the requirement of first dose of diclofenac was longer in group B compared to group S (360 min vs 30 min, P < 0.01). The number of doses of diclofenac (5 vs 19) was significantly lower in group B compared to group S (P < 0.01). Tramadol was required by six patients in group S only. Scalp nerve block using 0.5% bupivacaine with 1:400,000 adrenaline decreases the incidence and severity of postoperative pain in patients undergoing supratentorial craniotomy.
在40例接受幕上开颅手术的美国麻醉医师协会（ASA）I或II级成年患者中，评估了使用0.5%布比卡因加肾上腺素进行头皮神经阻滞对开颅手术患者术后疼痛缓解的效果。采用标准的全身麻醉技术。患者被随机分为两组。B组在皮肤缝合后接受0.5%布比卡因加1:400,000肾上腺素，S组接受含1:400,000肾上腺素的生理盐水。术后30秒以及1、2、4、6、8和12小时使用数字评分量表评估疼痛。如果患者报告数字评分量表为40或更高，则给予双氯芬酸肌内注射作为补救镇痛。给予曲马多静脉注射作为第二补救镇痛。与B组25%的患者相比，S组60%的患者在术后12小时内的某个时间经历了中度至重度疼痛（数字评分量表为40或更高）。B组的中位疼痛评分在长达6小时内显著更低。B组在长达4小时内无痛的患者明显更多。与S组相比，B组首次使用双氯芬酸的中位时间更长（360分钟对30分钟，P<0.01）。B组的双氯芬酸剂量数（5对19）明显低于S组（P<0.01）。仅S组有6例患者需要使用曲马多。使用0.5%布比卡因加1:400,000肾上腺素进行头皮神经阻滞可降低幕上开颅手术患者术后疼痛的发生率和严重程度。
