Ning Li, Jiang Lai, Zhang Qingqing, Luo Mengqiang, Xu Daojie, Peng Yuanzhi
Department of Anesthesiology and Surgical Intensive Care Unit, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
Front Med (Lausanne). 2022 Sep 7;9:952064. doi: 10.3389/fmed.2022.952064. eCollection 2022.
Scalp nerve block (SNB) is widely used for postoperative pain control, intraoperative hemodynamic control, and opioid-sparing in adult craniotomies. However, there are few studies of SNB in pediatric patients undergoing craniotomy. In the present study, we aimed to investigate the effect of SNB on postoperative pain, intraoperative hemodynamic stability, and narcotic consumption in pediatric craniotomy under general anesthesia.
This trial is a single-center, prospective, randomized, and double-blind study. A total of 50 children aged between 2 and 12 years who are undergoing elective brain tumor surgery will be randomly allocated in a 1:1 ratio to receive either 0.2% ropivacaine for SNB (group SNB, intervention group, = 25) or the same volume of saline (group Ctrl, control group, = 25). The primary outcome was to assess the score of postoperative pain intensity at time 1, 4, 8, 12, 24, and 48 h postoperatively using the FLACC score method. Secondary outcomes were to record intraoperative hemodynamic variables (MAP and HR) during skull-pin fixation, skin incision and end of skin closure, intraoperative total consumption of remifentanil and propofol, postoperative opioid consumption, and the incidence of postoperative nausea and vomiting.
Fifty patients were analyzed ( = 25 in SNB group; = 25 in control group). Compared to the control group, postoperative pain intensity was significantly relieved in the SNB group up to 8 h post-operatively. In addition, SNB provided good intraoperative hemodynamic stability, reduced intraoperative overall propofol and remifentanil consumption rate, and postoperative fentanyl consumption compared to the control group. However, the incidence of postoperative nausea and vomiting was not different between SNB and the control group.
In pediatric craniotomies, SNB with 0.2% ropivacaine provides adequate postoperative pain control and good intraoperative hemodynamic stability during noxious events compared to the control group.
Chinese Clinical Trial Registry [No: ChiCTR2100050594], Prospective registration.
头皮神经阻滞（SNB）广泛应用于成人开颅手术的术后疼痛控制、术中血流动力学控制及阿片类药物节省。然而，关于SNB在小儿开颅手术患者中的研究较少。在本研究中，我们旨在探讨SNB对全身麻醉下小儿开颅手术术后疼痛、术中血流动力学稳定性及麻醉药物消耗的影响。
本试验为单中心、前瞻性、随机、双盲研究。共50名年龄在2至12岁行择期脑肿瘤手术的儿童将按1:1比例随机分配，分别接受0.2%罗哌卡因用于SNB（SNB组，干预组，n = 25）或相同体积的生理盐水（Ctrl组，对照组，n = 25）。主要结局是使用FLACC评分法评估术后1、4、8、12、24和48小时的术后疼痛强度评分。次要结局是记录颅骨固定、皮肤切开和皮肤缝合结束时的术中血流动力学变量（平均动脉压和心率）、术中瑞芬太尼和丙泊酚的总消耗量、术后阿片类药物消耗量以及术后恶心呕吐的发生率。
分析了50例患者（SNB组25例；对照组25例）。与对照组相比，SNB组术后疼痛强度在术后8小时内得到显著缓解。此外，与对照组相比，SNB提供了良好的术中血流动力学稳定性，降低了术中丙泊酚和瑞芬太尼的总体消耗率以及术后芬太尼消耗量。然而，SNB组与对照组术后恶心呕吐的发生率无差异。
在小儿开颅手术中，与对照组相比，0.2%罗哌卡因的SNB可提供充分的术后疼痛控制，并在有害事件期间保持良好的术中血流动力学稳定性。
中国临床试验注册中心[编号：ChiCTR2100050594]，前瞻性注册。
