在幕下开颅术中，哪种方法用于镇痛更有效？是头皮阻滞还是局部麻醉浸润？
Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration.
作者信息
Akcil Eren Fatma, Dilmen Ozlem Korkmaz, Vehid Hayriye, Ibısoglu Lutfiye Serap, Tunali Yusuf
机构信息
University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey.
University of Istanbul, Cerrahpasa School of Medicine, Department of Biostatistics, Turkey.
出版信息
Clin Neurol Neurosurg. 2017 Mar;154:98-103. doi: 10.1016/j.clineuro.2017.01.018. Epub 2017 Jan 30.
OBJECTIVES
The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h.
METHODS
This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared.
RESULTS
The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period.
CONCLUSION
The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.
目的
开颅手术最痛苦的阶段是放置头钉固定器和皮肤切口。本研究的主要目的是比较头皮阻滞和0.5%布比卡因局部麻醉浸润对幕下开颅手术中放置头钉固定器和皮肤切口期间血流动力学反应的影响。次要目的是对术后24小时内疼痛评分和吗啡用量的影响。
方法
这项前瞻性、随机和安慰剂对照研究纳入了47例患者（ASA I、II和III级）。S组进行头皮阻滞，I组进行局部麻醉浸润，对照组（C组）在手术期间仅接受瑞芬太尼作为镇痛药。比较了放置头钉固定器和皮肤切口时的血流动力学反应，以及术后疼痛强度、吗啡累积用量和阿片类药物相关副作用。
结果
头皮阻滞降低了幕下开颅手术中放置头钉固定器和皮肤切口时的血流动力学反应。局部麻醉浸润降低了对皮肤切口的血流动力学反应。此外，头皮阻滞和局部麻醉浸润均降低了术后24小时内的吗啡累积用量。而且，术后早期头皮阻滞后疼痛强度较低。
结论
在幕下开颅手术中，头皮阻滞可能比局部麻醉浸润提供更好的镇痛效果。
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