Scalp block for analgesia after craniotomy: A meta-analysis

Abstract

Background and Aims:A previous meta-analysis reported that scalp block had limited benefits (low-quality evidence) compared to no-scalp block modalities for analgesia after craniotomy. However, it included studies using two different pain intensity measurement scales. Therefore, we performed another meta-analysis using a single scale.Methods:We conducted the search for all randomised controlled trials evaluating the effect of scalp block on postcraniotomy pain compared to no-scalp block in Cochrane Central Register of Controlled Trials and PubMed database. We assessed the quality of included studies employing GRADE approach. We performed random-effects inverse-variance weighted meta-analysis of outcomes including pain intensity assessed by a 0--10 visual analog scale and opioid consumption during the first 24 h postoperative period using RevMan 5.3.Results:A total of 10 studies (551 patients) were included. It revealed a statistically significant mean pain intensity reduction in scalp block group when compared to no-scalp block at very early and early 24 h period (seven trials, very low-quality evidence, mean difference (MD) = −1.37, 95% confidence interval (CI): −2.23 to -0.05, I2 = 70%; nine trials, very low-quality evidence, MD = −1.16, 95% CI: −2.09 to −0.24, I2 = 57%, respectively). There was also reduction in the opioid requirements over the first 24 h postoperatively.Conclusion:Scalp block might be useful at <6 h postcraniotomy with very-low quality evidence. Additionally, it had uncertain but moderate effect on reducing total 24 h opioid consumption. Therefore, more studies are needed to reach optimal information size.

Comparison of effects of dexmedetomidine added to ropivacaine versus ropivacaine alone infiltration scalp block for attenuation of the haemodynamic response to skull pin placement in neurosurgical procedures: A double-blind, randomised clinical trial

“…[ 8 ] Local anaesthesia infiltration is the cornerstone to blunt the noxious stimuli of skull pin insertion, and is typically provided by means of a scalp block, which when performed well with agents such as bupivacaine, levobupivacaine or ropivacaine can provide good and safe analgesia for 8 h or longer. [ 9 10 ]…”

Faculty Opinions recommendation of Regional anesthesia in neuroanesthesia practice.

“…Adjuvants like opioids, dexmedetomidine 12 , dexamethasone and magnesium sulphate 13 have been investigated by different investigators for their effect on the improvement of the quality and duration of the block with varying results. Meta-analysis of different randomised control studies (RCTs) have demonstrated a consistent reduction of pain severity 14 , which extends 6 hours after craniotomy 15 . A moderate reduction in opioid consumption in the 24 hours following craniotomy is also observed 16 .…”

“…A moderate reduction in opioid consumption in the 24 hours following craniotomy is also observed 16 . Additionally, it reduces the incidences of postoperative nausea and vomiting, which is usually associated with opioid usage for analgesia 15 .…”

Neural blocks at the helm of a paradigm shift in enhanced recovery after surgery (ERAS)

“…A meta-analysis of ten studies published in a previous issue of the IJA concluded that scalp block might be useful at less than 6 h postcraniotomy with very low-quality evidence. [ 44 ] It is observed that a majority of scientific literature is focussed towards the immediate outcomes of surgery; nevertheless, the assessment of intermediate and long-term outcomes with nerve blocks is also important and needs further evaluation.…”