Kitsiripant Chanatthee, Boonyamarn Aunchitha, Oofuvong Maliwan, Prathep Sumidtra, Kaewborisutsakul Anukoon
Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Department of Surgery, Neurological Surgery Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Surg Neurol Int. 2024 Jun 7;15:191. doi: 10.25259/SNI_255_2024. eCollection 2024.
Remifentanil is favored for neurosurgical pain management, but its utilization in low- and middle-income countries (LMICs) is limited. Scalp block techniques are effective in LMICs, but cost-effectiveness is uncertain. This study compares costs and perioperative outcomes of scalp block versus fentanyl infusion in patients undergoing elective supratentorial craniotomy.
A prospective double-blind randomized controlled trial was conducted with 36 patients aged 18- 65 years undergoing elective supratentorial craniotomy. Patients were randomly assigned to receive either scalp block with 0.5% bupivacaine (Group S) or fentanyl infusion (Group F), with normal saline placebo administered in both groups. The primary endpoint was the anesthetic costs, with secondary endpoints including perioperative opioid consumption, intraoperative hemodynamic changes, and perioperative complications.
The cost of fentanyl was significantly lower than that of local anesthetics (3.31 [3.31, 3.75] vs. 4.27 [4.27, 4.27] United States dollars, < 0.001). However, the overall anesthetic cost did not differ significantly between groups. Group F demonstrated a significant reduction in mean arterial pressure immediately and 5 min after pin insertion compared to Group S (75.8 [13.9] vs. 92.5 [16.9] mmHg, = 0.003 and 67.7 [6.4] vs. 78.5 [10.7] mmHg, < 0.001, respectively).
Fentanyl infusion presents cost advantages over scalp block in LMIC settings. However, prudent opioid use is imperative. This study underscores the need for ongoing research to optimize neurosurgical pain management and evaluate long-term safety implications.
瑞芬太尼常用于神经外科手术的疼痛管理，但其在低收入和中等收入国家（LMICs）的应用有限。头皮阻滞技术在LMICs中有效，但成本效益尚不确定。本研究比较了择期幕上开颅手术患者头皮阻滞与芬太尼输注的成本和围手术期结局。
对36例年龄在18至65岁之间接受择期幕上开颅手术的患者进行了一项前瞻性双盲随机对照试验。患者被随机分配接受0.5%布比卡因头皮阻滞（S组）或芬太尼输注（F组），两组均给予生理盐水安慰剂。主要终点是麻醉成本，次要终点包括围手术期阿片类药物消耗、术中血流动力学变化和围手术期并发症。
芬太尼的成本显著低于局部麻醉药（3.31[3.31，3.75]美元对4.27[4.27，4.27]美元，<0.001）。然而，两组之间的总体麻醉成本没有显著差异。与S组相比，F组在插入针后即刻和5分钟时平均动脉压显著降低（分别为75.8[13.9]mmHg对92.5[16.9]mmHg，=0.003；67.7[6.4]mmHg对78.5[10.7]mmHg，<0.001）。
在LMIC环境中，芬太尼输注比头皮阻滞具有成本优势。然而，必须谨慎使用阿片类药物。本研究强调需要持续开展研究，以优化神经外科手术的疼痛管理并评估长期安全性影响。
