Nassar Heba, Sarhan Khaled, Gamil Maha, Elgohary Manal, El-Hadi Hany, Mahmoud Sahar
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
J Neurosurg Anesthesiol. 2024 Apr 1;36(2):159-163. doi: 10.1097/ANA.0000000000000899. Epub 2023 Jan 9.
Posterior fossa surgery is commonly associated with severe postoperative pain. This study assessed the impact of ultrasound-guided greater occipital nerve (GON) block on postoperative pain and hemodynamic profiles in pediatric posterior fossa craniotomy.
Children aged 2 to 12 years undergoing elective posterior fossa craniotomy with general anesthesia were randomly allocated to a control group receiving standard care (n=18) or a GON block group receiving standard care plus bilateral ultrasound-guided GON block (=17). Outcomes were postoperative pain assessed using the objective pain scale, time to first postoperative analgesia, intraoperative fentanyl consumption, perioperative blood pressure and heart rate, incidence of nausea and vomiting, and nerve-block-related complications.
Objective pain scale scores were lower in the GON block group than in the control group at 2, 4, 6, 8 (all P =0.0001), 12 ( P =0.001), 16 ( P =0.03), and 24-hour ( P =0.004) postoperatively. The time to first analgesic request was 13.4±7.4 hours in the GON block group and 1.8±1.5 hours in the control group ( P <0.001). Intraoperative fentanyl consumption was 2.68±0.53 μg/kg -1 in the GON block group and 4.1±0.53 μg/kg -1 in the control group ( P =0.0001). Systolic blood pressure was lower in the GON block group at several intraoperative and postoperative time points, whereas heart rate was similar in the two groups at most time points. The incidence of postoperative nausea and vomiting was similar between groups ( P =0.38), and there were no nerve-block-related complications.
In children undergoing posterior fossa craniotomy, GON block was associated with superior quality and duration of postoperative analgesia and better hemodynamic profile compared with standard care.
后颅窝手术通常会伴有严重的术后疼痛。本研究评估了超声引导下枕大神经（GON）阻滞对小儿后颅窝开颅术后疼痛及血流动力学指标的影响。
将年龄在2至12岁、接受全身麻醉下择期后颅窝开颅手术的儿童随机分为对照组（n = 18），接受标准护理；以及GON阻滞组（n = 17），接受标准护理加双侧超声引导下GON阻滞。观察指标包括使用客观疼痛量表评估的术后疼痛、首次术后镇痛时间、术中芬太尼用量、围手术期血压和心率、恶心呕吐发生率以及神经阻滞相关并发症。
GON阻滞组术后2、4、6、8小时（均P = 0.0001）、12小时（P = 0.001）、16小时（P = 0.03）和24小时（P = 0.004）的客观疼痛量表评分均低于对照组。GON阻滞组首次镇痛需求时间为13.4±7.4小时，对照组为1.8±1.5小时（P <0.001）。GON阻滞组术中芬太尼用量为2.68±0.53μg/kg -1，对照组为4.1±0.53μg/kg -1（P = 0.0001）。在几个术中和术后时间点，GON阻滞组的收缩压较低，而在大多数时间点两组心率相似。两组术后恶心呕吐发生率相似（P = 0.38），且无神经阻滞相关并发症。
对于接受后颅窝开颅手术的儿童，与标准护理相比，GON阻滞可带来更高质量和更长时间的术后镇痛，以及更好的血流动力学指标。
