&lt;p&gt;Pre-emptive scalp infiltration with dexamethasone plus ropivacaine for postoperative pain after craniotomy: a protocol for a prospective, randomized controlled trial&lt;/p&gt;

Jia, Yitong; Zhao, Chunli; Ren, Huajian; Wang, Tao; Luo, Fang

doi:10.2147/jpr.s190679

Cited by 9 publications

(3 citation statements)

References 42 publications

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“…The inadequate control of pain after craniotomy is a critical issue in the perioperative management of neurosurgical patients as it relates to worse surgical outcomes [ 91 , 92 ]. Agitation and the consequent activation of the sympathetic nervous system can cause complications during the primary post-operative period, leading to secondary neurological injury [ 6 , 93 ].…”

Section: Discussionmentioning

confidence: 99%

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

et al. 2023

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Background and Objective: To analyze the effects of several drug for pain prevention in adults undergoing craniotomy for elective brain surgery. Material and Methods: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated the effectiveness of pharmacological treatments for preventing post-operative pain in adults (aged 18 years or older) undergoing craniotomies. The main outcome measures were represented by the mean differences in validated pain intensity scales administered at 6 h, 12 h, 24 h and 48 h post-operatively. The pooled estimates were calculated using random forest models. The risk of bias was evaluated using the RoB2 revised tool, and the certainty of evidence was assessed according to the GRADE guidelines. Results: In total, 3359 records were identified through databases and registers’ searching. After study selection, 29 studies and 2376 patients were included in the meta-analysis. The overall risk of bias was low in 78.5% of the studies included. The pooled estimates of the following drug classes were provided: NSAIDs, acetaminophen, local anesthetics and steroids for scalp infiltration and scalp block, gabapentinoids and agonists of adrenal receptors. Conclusions: High-certainty evidence suggests that NSAIDs and acetaminophen may have a moderate effect on reducing post-craniotomy pain 24 h after surgery compared to control and that ropivacaine scalp block may have a bigger impact on reducing post-craniotomy pain 6 h after surgery compared to control. Moderate-certainty evidence indicates that NSAIDs may have a more remarkable effect on reducing post-craniotomy pain 12 h after surgery compared to control. No moderate-to-high-certainty evidence indicates effective treatments for post-craniotomy pain prevention 48 h after surgery.

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Section: Discussionmentioning

confidence: 99%

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

et al. 2023

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“…The pharmacist in charge was allowed to unmask drug allocation only in case of SAEs. The respective drugs to be used for incision-site infiltration were prepared by an independent study investigator in the two groups: 10 mg dexamethasone, 150 mg ropivacaine diluted to a total volume of 30 mL in 0.9% saline in the dexamethasone group, 16,20 and 150 mg ropivacaine diluted to a total volume of 30 mL in 0.9% saline in the control group. The concentration of ropivacaine was 0.5% in both groups.…”

Section: Randomization and Maskingmentioning

confidence: 99%

Pre-Emptive Incision-Site Infiltration with Ropivacaine Plus Dexamethasone for Postoperative Pain After Supratentorial Craniotomy: A Prospective Randomized Controlled Trial

Zhao¹,

Wang²,

Pan³

et al. 2021

JPR

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Background: Incision-site infiltration with local anesthetics prevents pain on incision site, but pain relief is limited to the first few postoperative hours. Dexamethasone as an adjuvant to local infiltration successfully achieves better postoperative pain relief; however, this has not been studied in craniotomy patients yet. Study Design and Methods: This is a prospective, single-center, blinded, randomized, controlled trial included patients aged between 18 and 64 years, ASA physical status of I-II, scheduled for elective supratentorial tumor craniotomy under general anesthesia. We screened patients for enrollment from April 4, 2019 through August 15, 2019. The final study visit of the last patient was conducted on February 13, 2020. We randomly assigned eligible participants (1:1) to either the dexamethasone group who received incision-site infiltration of 0.5% ropivacaine plus 0.033% dexamethasone (N=70) or the control group who received 0.5% ropivacaine alone (N=70). Primary outcome was the cumulative sufentanil consumption (μg) within 48 hours postoperatively. Primary analysis was performed based on the modified intention-to-treat (MITT) principle. Results: Baseline characteristics were similar between the groups (p>0.05). Sufentanil consumption during the first 48 hours postoperatively was 29.0 (10.7) μg in the dexamethasone group and 38.3 (13.7) μg in the control group (mean difference −9.3, 95% CI −13.4 to −5.1; p<0.001). There was no serious adverse effect directly associated with incision-site infiltration or local dexamethasone use. Conclusion:The addition of dexamethasone to pre-emptive incision-site infiltration with the local anesthetic can reduce about 27% of opioids consumption and the postoperative pain scores within 72 hours after craniotomy. Trial Registration: ClinicalTrials.Gov (NCT03618264).

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“…Just one study showed that ropivacaine combined with dexamethasone for supraclavicular brachial plexus nerve block prolonged motor and sensory block [ 7 ]. It has also been shown that in the use of craniotomy, scalp infiltration with ropivacaine combined with dexamethasone delivered better postoperative analgesia than ropivacaine alone [ 8 ]. However, less is known about the mechanism of action of ropivacaine alone or its combination with dexamethasone.…”

Section: Introductionmentioning

confidence: 99%

A Bioinformatics Study of Ropivacaine plus Dexamethasone Prolonging the Duration of Nerve Block

Chen

et al. 2022

Computational Intelligence and Neuroscience

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The study focuses on the potential function of dexamethasone on ropivacaine in sciatic nerve blocks. Nine Sprague–Dawley (SD) rats were randomly divided into three groups: normal group (NG), control group (CG), and experimental group (EG), with three rats in each group. The CG was injected with diluted ropivacaine (0.5% concentration); the EG was injected with a diluted ropivacaine+dexamethasone mixture, and the NG was injected with an equal amount of saline. The sciatic nerve in the thigh was collected for sequencing two days after injection in each group. Differential analysis was performed for NG-vs-CG, NG-vs-EG, and CG-vs-EG based on the sequencing dataset. The modular genes associated with ropivacaine and ropivacaine+ dexamethasone were screened by weighted coexpression network analysis (WGCNA), differentially expressed modules among them were enriched for analysis, and protein-protein interaction (PPI) networks were constructed to observe high and low expression among key genes in immune cells. Twenty-two and three differential genes associated with ropivacaine (green-yellow module) and ropivacaine+dexamethasone (palevioletred3 module) were acquired, respectively, which played important roles in biological processes such as erythrocyte homeostasis, erythroid differentiation, and hemoglobin metabolic processes. PPI revealed that AHSP, ALAS2, EPB42, HBB, and SLC4A1 were interacting and the expression of these five genes was upregulated in the CG compared with the NG, while the expression of them was downregulated in the EG compared with the CG. The immunological analysis also showed significant differences in the expression of various immune cells in the 3 groups. AHSP, ALAS2, EPB42, HBB, and SLC4A1 are genes associated with hemoglobin, and dexamethasone combined with ropivacaine may prolong anesthesia by affecting local vasoconstriction to some extent.

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<p>Pre-emptive scalp infiltration with dexamethasone plus ropivacaine for postoperative pain after craniotomy: a protocol for a prospective, randomized controlled trial</p>

Cited by 9 publications

References 42 publications

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

Prevention of Post-Operative Pain after Elective Brain Surgery: A Meta-Analysis of Randomized Controlled Trials

Pre-Emptive Incision-Site Infiltration with Ropivacaine Plus Dexamethasone for Postoperative Pain After Supratentorial Craniotomy: A Prospective Randomized Controlled Trial

A Bioinformatics Study of Ropivacaine plus Dexamethasone Prolonging the Duration of Nerve Block

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