Cata Juan P, Bhavsar Shreyas, Hagan Katherine B, Arunkumar Radha, Shi Ted, Grasu Roxana, Dang Anh, Carlson Richard, Arnold Benjamin, Popat Keyuri, Potylchansky Yuri, Lipski Ian, Raty Sally, Nguyen Anh T, McHugh Thomas M, Feng Lei, Rahlfs Thomas F
Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
J Clin Neurosci. 2018 May;51:46-51. doi: 10.1016/j.jocn.2018.02.022. Epub 2018 Mar 5.
To test the association between the use of scalp blocks for malignant brain tumor craniotomy and survival. This is a retrospective study conducted in a tertiary academic center. Demographic, intraoperative and survival data from 808 adult patients with malignant brain tumors was included in the analysis. Patients were divided in those who received an Intraoperative use of scalp block or not. The progression free survival (PFS) and overall survival (OS) rates were compared in patients who had and had not scalp blocks. Kaplan-Meier method was used for time-to-event analysis including recurrence free survival and overall survival. Multivariate analyses before and after propensity score matching were conducted to test the association between different covariates including scalp blocks with PFS and OS. Five hundred and ninety (73%) of the patients had a scalp block. Before PSM, patients with a scalp block were more likely to have an ASA physical status of 3-4, recurrent tumors and receive adjuvant radiation. Patients with scalp block showed no significant reduction in intraoperative opioids. After adjusting for significant covariates, the administration of a scalp block was not associated with an increase in PFS (HR, 95%CI = 0.98, 0.8-1.2, p = 0.892) or OS (HR, 95%CI = 1.02, 0.82-1.26, p = 0.847) survival. This retrospective study suggests that the use of scalp blocks during brain tumor surgery is not associated with patients' longer survival.
为了测试在恶性脑肿瘤开颅手术中使用头皮阻滞与生存之间的关联。这是一项在三级学术中心进行的回顾性研究。分析纳入了808例成年恶性脑肿瘤患者的人口统计学、术中及生存数据。患者被分为术中使用头皮阻滞和未使用头皮阻滞两组。比较了使用和未使用头皮阻滞患者的无进展生存期（PFS）和总生存期（OS）率。采用Kaplan-Meier方法进行包括无复发生存期和总生存期在内的事件发生时间分析。在倾向得分匹配前后进行多变量分析，以测试包括头皮阻滞在内的不同协变量与PFS和OS之间的关联。590例（73%）患者使用了头皮阻滞。在倾向得分匹配前，使用头皮阻滞的患者更有可能具有ASA身体状况3-4级、复发性肿瘤并接受辅助放疗。使用头皮阻滞的患者术中阿片类药物用量无显著减少。在调整显著协变量后，头皮阻滞的使用与PFS（HR，95%CI = 0.98，0.8-1.2，p = 0.892）或OS（HR，95%CI = 1.02，0.82-1.26，p = 0.847）生存期的增加无关。这项回顾性研究表明，脑肿瘤手术期间使用头皮阻滞与患者更长的生存期无关。
