Zeng Min, Li Ruowen, Xu Xin, Wang Dexiang, Dong Jia, Li Shu, Kass Ira S, Peng Yuming, Jia Wang
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China.
Anesthesiology and Physiology & Pharmacology Departments, SUNY Downstate Health Sciences University, Brooklyn, New York, USA.
Reg Anesth Pain Med. 2022 Jun 29. doi: 10.1136/rapm-2022-103534.
The effectiveness of superficial cervical plexus block (SCPB) at decreasing opioid use and improving hemodynamic stability during suboccipital retrosigmoid craniotomy has not been established. The aim of this study is to evaluate the analgesic effect of preoperative ultrasound-guided SCPB for craniotomy via a suboccipital retrosigmoid approach.
This was a prospective, single-center, randomized, double-blind, parallel-group controlled trial. One hundred and six adult patients undergoing suboccipital retrosigmoid craniotomy were randomly allocated into either the SCPB group (n=53) to receive 10 mL of 0.5% ropivacaine or the control group (n=53) to receive 0.9% normal saline injected into the superficial layer of prevertebral fascia guided by ultrasound. The primary outcome was the cumulative consumption of sufentanil with patient-controlled intravenous analgesia (PCIA) within 24 hours. Secondary outcomes included the overall perioperative consumption of opioids, the area under the curve of the pain score from 1 hour to 48 hours (AUC), intraoperative hemodynamic parameters, and anesthesia depth.
The mean PCIA pump cumulative consumption of sufentanil in the first 24 hour postoperative period was significantly lowered by SCPB (5.0 µg vs 9.8 µg, 95% CI: -8.0 to -2.4; p=0.001). The total perioperative consumption of sufentanil (45.0 µg vs 54.5 µg, 95% CI: -14.8 to -4.1; p=0.001) was also significantly decreased by SCPB. The incidence of severe pain within 24 hours was decreased by SCPB (7.5% vs 26.4%, p=0.01). SCPB significantly decreased the AUC of the pain score. Intraoperative hemodynamic parameters and anesthesia depth were similar between groups (p>0.05).
SCPB provides effective analgesia in patients undergoing craniotomy and tumor resection via suboccipital retrosigmoid approach. SCPB demonstrates an opioid-sparing effect and allows for the maintenance hemodynamic stability at an appropriate depth of anesthesia.
NCT04036812.
枕下乙状窦后开颅术中，颈浅丛阻滞（SCPB）在减少阿片类药物使用及改善血流动力学稳定性方面的有效性尚未得到证实。本研究旨在评估术前超声引导下SCPB用于枕下乙状窦后入路开颅术的镇痛效果。
这是一项前瞻性、单中心、随机、双盲、平行组对照试验。106例接受枕下乙状窦后开颅术的成年患者被随机分为SCPB组（n = 53），接受10 mL 0.5%罗哌卡因，或对照组（n = 53），接受在超声引导下注入椎前筋膜浅层的0.9%生理盐水。主要结局是患者自控静脉镇痛（PCIA）24小时内舒芬太尼的累计用量。次要结局包括围手术期阿片类药物的总用量、1小时至48小时疼痛评分的曲线下面积（AUC）、术中血流动力学参数及麻醉深度。
SCPB显著降低了术后24小时内舒芬太尼的平均PCIA泵累计用量（5.0μg对9.8μg，95%CI：-8.0至-2.4；p = 0.001）。SCPB还显著降低了舒芬太尼的围手术期总用量（45.0μg对54.5μg，95%CI：-14.8至-4.1；p = 0.001）。SCPB降低了24小时内重度疼痛的发生率（7.5%对26.4%，p = 0.01）。SCPB显著降低了疼痛评分的AUC。两组术中血流动力学参数及麻醉深度相似（p>0.05）。
SCPB为接受枕下乙状窦后入路开颅术及肿瘤切除术的患者提供了有效的镇痛效果。SCPB显示出阿片类药物节省效应，并能在适当的麻醉深度维持血流动力学稳定。
NCT04036812。
