Department of Anesthesiology, Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia.
Department of Anesthesiology, Critical Care and Pain Medicine, Sapienza University of Rome, Rome, Italy.
Clin J Pain. 2021 Mar 1;37(3):194-198. doi: 10.1097/AJP.0000000000000905.
Postoperative pain after craniotomy is a significant clinical problem that is sometimes underestimated, although moderate or severe pain in early postoperative period complicates up to 60% of cases. The purpose of this prospective randomized multicenter trial was to determine the optimal timing for selective scalp block in patients undergoing general anesthesia for supratentorial craniotomy.
After ethics committee approval and informed consent, 56 adult patients were enrolled, and randomly assigned to receive a selective scalp block combined with incision line infiltration preoperatively or postoperatively.
Postoperative pain at 24 hours after the procedure was recorded in all 56 enrolled patients. In patients assigned to receive a scalp block preoperatively, median VAS score at 24 hours after surgery was 0 (0 to 2), and in patients assigned to receive a scalp block postoperatively it was 0 (0 to 3) (P>0.05). There was no difference in severity of pain at 24, 12, 6, and 2 hours after surgery between the 2 study groups, but the amount of fentanyl administered intraoperatively was lower in patients assigned to the preoperative scalp block group (1.6±0.7 vs. 2.4±0.7 mkg/kg/h, P=0.01).
This study confirms and extends available clinical evidence on the safety and efficacy of selective scalp blocks for the prevention of postoperative pain. Recorded data suggest that there is no difference in terms of occurrence and severity of postoperative pain regardless of whether the scalp block is performed preoperatively (after general anesthesia induction) or postoperatively (before extubation). Patients assigned to receive a scalp block combined with incision line infiltration preoperatively needed less intraoperative opioids than those assigned to postoperative scalp block.
开颅术后疼痛是一个严重的临床问题，有时被低估了，尽管在早期术后阶段，中度或重度疼痛会使多达 60%的病例变得复杂。本前瞻性随机多中心试验的目的是确定选择性头皮阻滞在接受全身麻醉行幕上开颅术的患者中的最佳时机。
在伦理委员会批准和知情同意后，纳入了 56 名成年患者，并随机分配接受预防性或术后选择性头皮阻滞联合切口线浸润。
所有 56 名入组患者均记录了术后 24 小时的术后疼痛。在术前接受头皮阻滞的患者中，术后 24 小时的中位数 VAS 评分为 0（0 至 2），在术后接受头皮阻滞的患者中为 0（0 至 3）（P>0.05）。术后 24、12、6 和 2 小时，两组患者的疼痛严重程度无差异，但术前头皮阻滞组术中芬太尼用量较低（1.6±0.7 vs. 2.4±0.7 mkg/kg/h，P=0.01）。
本研究证实并扩展了关于预防性选择性头皮阻滞预防术后疼痛的安全性和有效性的现有临床证据。记录的数据表明，无论头皮阻滞是在术前（全麻诱导后）还是术后（拔管前）进行，术后疼痛的发生和严重程度均无差异。与术后头皮阻滞组相比，术前接受头皮阻滞联合切口线浸润的患者需要的术中阿片类药物较少。
