Regional Scalp Block for Postcraniotomy Analgesia

Guilfoyle, Matthew R.; Helmy, Adel; Duane, Derek; Hutchinson, Peter J.

doi:10.1213/ane.0b013e3182863c22

Cited by 165 publications

(155 citation statements)

References 29 publications

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“…In contrast, pre-incisional ultrasound-guided ilioinguinal/iliohypogastric nerve blocks did not reduce EA after ambulatory paediatric hernia repair, although nerve block decreased the amount of intraoperative sevoflurane needed. 1 The single intravenous injection of remifentanil 1 lg/kg that was administered just prior to skin incision in the remifentanil group was enough to achieve an end-tidal concentration of sevoflurane during surgery comparable with that in the block group. A pre-incisional blockade of the major scalp nerves and/or infiltration of anaesthesia around the nevi can block nociceptive pain arising from the wound completely for a few hours.…”

Section: Discussionmentioning

confidence: 93%

“…13 However, effect of postoperative pain relief by regional anaesthesia 6 previously reported that pre-incisional infraorbital nerve block decreased the incidence of EA effectively in children who underwent cleft lip surgery, but authors assumed that besides pain relief, the reduced amount of sevoflurane by nerve block during surgery might be an important factor in reducing the incidence of EA. 1 The scalp nerve block is a simple technique that can be performed rapidly, safely, and reliably. 14 In this study, we were able to maintain similar, end-tidal concentrations of sevoflurane during surgery, without a significant fluctuation of blood pressure, in both the remifentanil and block groups.…”

Section: Discussionmentioning

confidence: 99%

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Effects of scalp nerve block on pain and emergence agitation after paediatric nevus surgery: a clinical trial

Kim

Park

et al. 2017

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Effects of scalp nerve block on pain and emergence agitation after paediatric nevus surgery: a clinical trial

Kim

Park

et al. 2017

Acta Anaesthesiol Scand

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“…, Guilfoyle et al . ). Although pharmacological interventions exist, no one therapeutic medication has been identified as most efficacious (National Pharmaceutical Council , Paolino et al .…”

Section: Discussionmentioning

confidence: 97%

Integrative review: postcraniotomy pain in the brain tumour patient

Guilkey

Carpenter

et al. 2016

Journal of Advanced Nursing

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Aim To conduct an integrative review to examine evidence of pain and associated symptoms in adult (≥ 21 years of age), post-craniotomy, brain tumor patients hospitalized on intensive care units. Background Healthcare providers believe craniotomies are less painful than other surgical procedures. Understanding how post-craniotomy pain unfolds over time will help inform patient care and aid in future research and policy development. Design Systematic literature search to identify relevant literature. Information abstracted using the Theory of Unpleasant Symptoms’ concepts of influencing factors, symptom clusters and patient performance. Inclusion criteria were indexed, peer-reviewed, full-length, English-language articles. Keywords were ‘traumatic brain injury,’ ‘pain, post-operative,’ ‘brain injuries,’ ‘postoperative pain,’ ‘craniotomy,’ ‘decompressive craniectomy,’ and ‘trephining.’ Data sources Medline, OVID, PubMed and CINAHL databases from 2000 – 2014. Review Method Cooper’s five-stage integrative review method was used to assess and synthesize literature. Results The search yielded 115 manuscripts, with 26 meeting inclusion criteria. Most studies were randomized, controlled trials conducted outside of the United States. All tested pharmacological pain interventions. Post-craniotomy brain tumor pain was well-documented and associated with nausea, vomiting and changes in blood pressure and impacted patient length of hospital stay, but there was no consensus for how best to treat such pain. Conclusion The Theory of Unpleasant Symptoms provided structure to the search. Post-craniotomy pain is experienced by patients, but associated symptoms and impact on patient performance remain poorly understood. Further research is needed to improve understanding and management of post-craniotomy pain in this population.

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“…The pulsating or pounding headache that occurs in about two-thirds of patients undergoing a craniotomy [9,23] could result from damage to extracranial periosteal afferents, given that this headache can be alleviated by regional scalp nerve block [12,23]. The sensory innervation of the calvarial periosteum may also contribute to the development and maintenance of other calvarial-related head pain such as following head trauma.…”

Section: Discussionmentioning

confidence: 99%

The sensory innervation of the calvarial periosteum is nociceptive and contributes to headache-like behavior

Zhao

Levy

2014

Pain

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Headaches are thought to result from the activation and sensitization of nociceptors that innervate deep cephalic tissues. A large body of evidence supports the view that some types of headaches originate intracranially, from activation of sensory neurons that innervate the cranial meninges. However the notion of an extracranial origin of headaches continues to be entertained, although the identity of deep extracranial cephalic tissues which might contribute to headaches remains elusive. Here we employed anatomical, electrophysiological, and behavioral approaches in rats to test the hypothesis that the sensory innervation of the calvarial periosteum is nociceptive. Neural tracing indicated that the calvarial periosteum overlying the frontal and parietal bones is innervated primarily by small and medium-sized neurons in the trigeminal ganglion’s ophthalmic division. In vivo single unit recording in the trigeminal ganglion revealed that calvarial periosteal afferents have slowly conducting axons, are mechanosensitive and respond to inflammatory mediators, consistent with a nociceptive function. Two distinct neuronal populations were distinguished based on their peripheral axonal trajectory: one that reached the periosteum through extracranial branches of the trigeminal nerve, and another that took an intracranial trajectory, innervating the cranial dura and apparently reaching the periosteum via the calvarial sutures. In behavioral studies, inflammatory stimulation of these afferents promoted periorbital tactile hypersensitivity, a sensory change linked to primary headaches. Activation and sensitization of calvarial periosteal afferents could play a role in mediating primary headaches of extracranial and perhaps also intracranial origin, as well as secondary headaches such as post-craniotomy and post-traumatic headaches. Targeting calvarial periosteal afferents may be effective in ameliorating these headaches.

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Regional Scalp Block for Postcraniotomy Analgesia

Abstract: Published RCTs of RSB are small and of limited methodological quality but meta-analysis shows a consistent finding of reduced postoperative pain. This evidence supports the use of RSB for patients undergoing craniotomy.

Cited by 165 publications

References 29 publications

Effects of scalp nerve block on pain and emergence agitation after paediatric nevus surgery: a clinical trial

Effects of scalp nerve block on pain and emergence agitation after paediatric nevus surgery: a clinical trial

Integrative review: postcraniotomy pain in the brain tumour patient

The sensory innervation of the calvarial periosteum is nociceptive and contributes to headache-like behavior

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