Skutulienė Juliana, Banevičius Gediminas, Bilskienė Diana, Macas Andrius
Department of Anaesthesiology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Eiveniu g. 2, 50161, Kaunas, Lithuania.
Medical Academy of the Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, 44307, Kaunas, Lithuania.
Acta Neurochir (Wien). 2022 May;164(5):1375-1379. doi: 10.1007/s00701-021-04886-0. Epub 2021 Jun 28.
This is a prospective, double-blind observational study in which different types of analgesia and its effect on postoperative pain reduction in patients undergoing craniotomy for brain tumor removal were compared.
The study included 141 adult craniotomy patients that were randomly separated into three equal groups. A group with scalp nerve blockade (B) and wound infiltration (I) received 0.25% bupivacaine combined with 1% lidocaine and 1:200,000 epinephrine. One gram of paracetamol and 2 mg/kg ketoprofen were administered intravenously (IV) after skin closure in a group with systemic analgesia (S). Pain intensity was evaluated after 1, 3, 6, and 24 h postoperatively using a visual analogue scale (VAS). The amount of rescue analgesia (ketorolac, paracetamol, and pethidine) and the duration for its first requirement were recorded.
One hundred and forty-one patients were included in the study. The main pain scores were significantly lower in the groups with regional anesthesia compared to group S in the first hours post-surgery (p < 0.05). Significantly lower pain scores were observed in the group with a scalp nerve blockade compared to the group with systemic analgesia or wound infiltration after 24 h (p < 0.05). Regional anesthesia ensured a stable analgesic effect for all 24 h. Patients in groups B and I required significantly fewer rescue analgesics compared to patients in group S. The duration for the requirement of the first rescue analgesia was significantly longer in groups B and I compared to group S (p = 0.000).
The results of our study show that most patients experience pain in the early postsurgical hours. Regional analgesia could help reduce the incidence and severity of pain after a craniotomy and the amount of rescue analgesia used in this group of patients.
这是一项前瞻性、双盲观察性研究，比较了不同类型的镇痛方法及其对接受脑肿瘤切除术的开颅手术患者术后疼痛减轻的影响。
该研究纳入了141例成年开颅手术患者，随机分为三组，每组人数相等。头皮神经阻滞（B）和伤口浸润（I）组接受0.25%布比卡因联合1%利多卡因和1:200,000肾上腺素。全身镇痛（S）组在皮肤缝合后静脉注射1克对乙酰氨基酚和2毫克/千克酮洛芬。术后1、3、6和24小时使用视觉模拟量表（VAS）评估疼痛强度。记录补救性镇痛药物（酮咯酸、对乙酰氨基酚和哌替啶）的用量及其首次需求的持续时间。
141例患者纳入研究。与S组相比，区域麻醉组在术后最初几小时的主要疼痛评分显著更低（p < 0.05）。24小时后，与全身镇痛组或伤口浸润组相比，头皮神经阻滞组的疼痛评分显著更低（p < 0.05）。区域麻醉在24小时内确保了稳定的镇痛效果。与S组患者相比，B组和I组患者所需的补救性镇痛药物明显更少。与S组相比，B组和I组首次需要补救性镇痛的持续时间显著更长（p = 0.000）。
我们的研究结果表明，大多数患者在术后早期会经历疼痛。区域镇痛有助于降低开颅手术后疼痛的发生率和严重程度，以及该组患者使用的补救性镇痛药物的用量。
