Preoperative regional scalp block versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia

Abstract

During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.

Pain management after elective craniotomy

“…41,46,47,49 These analgesic effects were also present in RCTs using basic analgesics. 45,47,49 Another RCT compared SNB with intra-operative DEX infusion. The pain scores were lower up to 2 h postoperatively, but the differences were not clinically significant.…”

“…[41][42][43][44][45][46][47][48][49] Eight out of the nine demonstrated that single injection SNB reduced pain scores, with a lasting effect from 2 to 48 h postoperatively, compared with placebo. [41][42][43][44][45][46][47]49 SNB also reduced postoperative opioid consumption in four studies. 41,46,47,49 These analgesic effects were also present in RCTs using basic analgesics.…”

“…[41][42][43][44][45][46][47]49 SNB also reduced postoperative opioid consumption in four studies. 41,46,47,49 These analgesic effects were also present in RCTs using basic analgesics. 45,47,49 Another RCT compared SNB with intra-operative DEX infusion.…”

“…Lidocaine was considered in a mixture with bupivacaine 5 mg.ml À1 in one study. [41][42][43][44][45][46][47][48][49][50][51][52] Two systematic reviews and three meta-analyses have assessed the analgesic effects of SNB when compared with placebo or control. 3,[53][54][55][56] The two systematic reviews (two RCTs included, n ¼ 70 53 and five RCTs included, n ¼ 237 55 ) concluded that SNB provided analgesia for a few hours postoperatively while asking for larger trials.…”

Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy

“…Of 955 studies, 22 RCTs met the inclusion criteria (Figure 1). 14,32-52 ClinicalTrials.gov search revealed 22 protocols; 13 completed ( Supplemental Materials, Appendix B , http://links.lww.com/NEU/D625). All trials meeting the inclusion criteria were either already captured or not yet available.…”