Regional Anesthesia to Scalp for Craniotomy

Jayaram, Kavitha; Moningi, Srilata; Kulkarni, Dilip Kumar; Ramachandran, Gopinath

doi:10.1097/ana.0000000000000184

Cited by 20 publications

(21 citation statements)

References 16 publications

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“…A previous meta‐analysis published in 2013 identified a positive impact of regional scalp block for postcraniotomy analgesia, but the RCTs included were small and of limited methodological quality . Up to now, only the 3 RCTs included in our study were performed, which seem not to provide strong evidence on scalp block analgesic efficacy . During the first 6 postoperative hours, the analgesic efficacy of scalp infiltration applied prior to surgery was superior to that performed upon skin closure, while the results from scalp block applied before awakening vs. placebo presented conflicting results, as the positive results in terms of pain and PONV control can be questioned by the equivalent overall consumption of fentanyl between groups.…”

Section: Discussionmentioning

confidence: 85%

“…Three RCTs of scalp infiltration or scalp nerve blocks vs. active control or placebo were identified and included a total of 138 patients. The analgesic efficacy of scalp infiltration using a mixture of ropivacaine 0.5% and lidocaine 1% applied either before skin incision or closure was evaluated by 1 RCT .…”

Section: Resultsmentioning

confidence: 99%

“…However, the overall consumption of fentanyl provided as a basic analgesic agent with a PCA device was similar between groups. When bilateral maxillary block was tested against scalp block applied after induction to anesthesia, it provided a better analgesic effect (became apparent at 12 hours postoperatively) and less need for rescue analgesia with diclofenac …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

2017

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No definite recommendations can be made based on this systematic review of pharamacological interventions following craniotomy due to significant divergence in the methodology of available studies. Limited evidence on scalp infiltration/block suggests an adequate analgesic effect in the early postoperative period. Analgesic efficacy of dexmedetomidine and multipoint electro-acupuncture needs further evaluation.

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Section: Discussionmentioning

confidence: 85%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

2017

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“…Sufentanil demonstrates better pain control, less nausea and vomiting, and better hemodynamic stability than morphine. Although paracetamol had fewer side effects of nausea and vomiting, it demonstrated the lowest amount of pain relief.While scalp anesthesia is the mainstay of treating craniotomy pain, Jayaram et al tested the efficacy of bilateral maxillary block with a greater and lesser occipital nerve block to control craniotomy pain in a cohort of 40 patients [2]. The VAS pain score was used.…”

mentioning

confidence: 99%

“…While scalp anesthesia is the mainstay of treating craniotomy pain, Jayaram et al tested the efficacy of bilateral maxillary block with a greater and lesser occipital nerve block to control craniotomy pain in a cohort of 40 patients [2]. The VAS pain score was used.…”

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confidence: 99%

Management of post-operative pain after craniotomy

Shah

Jung

2015

Acta Neurochir

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We have read with great interest a recently published article in Acta Neurochirurgica by Song et al. entitled "Preemptive scalp infiltration with 0.5 % ropivacaine and 1 % lidocaine reduces postoperative pain after craniotomy" [5]. In this study, a cohort of 60 patients undergoing craniotomy was enrolled, and it was reported that preemptive administration of 0.5 % ropivacaine and 1 % lidocaine provided effective postoperative analgesia after craniotomy when compared to administration of the same solution before skin closure: the mean time to demand for postoperative analgesic was statistically delayed, less than half of the number of patients required morphine, and the median morphine consumption was less.Post-craniotomy pain is a recurrent complication of neurosurgical procedures and is difficult to manage. Pain management is of great importance to avoid complications such as hypertension and vomiting, which may lead to elevation in intracranial pressure, negative outcomes, and extended hospital stay. While Song et al. provide a good approach to mitigating post-craniotomy pain, this letter was written to explore other forms of post-craniotomy pain management. Dexmedetomidine demonstrates promise for pain management. Peng et al. analyzed the effect of intraoperative dexmedetomidine on post-craniotomy pain by analyzing a cohort of 76 patients [3]. One group of patients was given a p l a c e b o , a n d o n e g r o u p r e c e i v e d a c o n t i n u o u s dexmedetomidine infusion of 0.5 μg/kg/h. Pain scores, tramadol consumption, and postoperative nausea and vomiting (PONV) scores were measured within the first 24 h after surgery. Dexmedetomidine was reported to reduce pain scores, tramadol consumption, and PONV scores. Song et al. also corroborated these findings and demonstrated that dexmedetomidine infusion lowered pain scores within 12 h postoperatively when compared to placebo [4]. Patients given dexmedetomidine required 54.4, 43.3, and 31.4 % less morphine than the placebo group during the first 4, 12, and 24 h, respectively.Besides dexmedetomidine, sufentanil is another agent that shows promise for pain management. In a cohort of 45 patients, Hassani et al. analyzed how effective sufentanil and paracetamol were in comparison to morphine at controlling pain post-craniotomy [1]. A visual analog scale (VAS) pain score was used, and there was a significant difference in postoperative pain. The patients on sufentanil demonstrated the most relief from pain with the lowest VAS score. Sufentanil demonstrates better pain control, less nausea and vomiting, and better hemodynamic stability than morphine. Although paracetamol had fewer side effects of nausea and vomiting, it demonstrated the lowest amount of pain relief.While scalp anesthesia is the mainstay of treating craniotomy pain, Jayaram et al. tested the efficacy of bilateral maxillary block with a greater and lesser occipital nerve block to control craniotomy pain in a cohort of 40 patients [2]. The VAS pain score was used. At 12 h postoperation, the maxillary...

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Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery

Galvin

Lévy

Day

et al. 2019

Cochrane Database of Systematic Reviews

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Regional Anesthesia to Scalp for Craniotomy

Abstract: Maxillary block along with greater and lesser occipital nerve block is an effective alternative to scalp block for craniotomy and has longer duration of analgesia.

Cited by 20 publications

References 16 publications

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature

Management of post-operative pain after craniotomy

Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery

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