A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial

• Published in: BMC anesthesiology Vol. 19; no. 1; p. 91
• Main Authors: Yang, Xi, Ma, Jing, Li, Ke, Chen, Lei, Dong, Rui, Lu, Yayuan, Zhang, Zongze, Peng, Mian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01.06.2019; BioMed Central; BMC
• Subjects: Alcohol; Analgesia; Anesthesia; Anesthesia, Local - methods; Anesthesiology; Anesthetics; Anesthetics, Local - administration & dosage; Anesthetics, Local - metabolism; Aneurysm; Blood pressure; Care and treatment; Cerebral aneurysm; Comparative analysis; Craniotomy; Craniotomy - adverse effects; Craniotomy - trends; Cytokines; Dosage and administration; Female; Hemodynamic responses; Hemodynamics - drug effects; Hemodynamics - physiology; Humans; Inflammation; Inflammation Mediators - antagonists & inhibitors; Inflammation Mediators - blood; Inflammatory response; Interleukin 10; Interleukin 6; Intracranial Aneurysm - blood; Intracranial Aneurysm - surgery; Intravenous administration; Intubation; Joint surgery; Knee; Local anesthesia; Local anesthetic infiltration; Local anesthetics; Male; Methods; Middle Aged; Narcotics; Nerve block; Nerve Block - methods; Neurophysiology; Oxycodone; Pain; Pain management; Pain Management - methods; Pain Management - trends; Pain perception; Pain, Postoperative - blood; Pain, Postoperative - prevention & control; Patient outcomes; Patients; Postcraniotomy pain; Postoperative pain; Postoperative period; Ropivacaine; Scalp; Scalp - drug effects; Scalp - innervation; Scalp - metabolism; Scalp nerve block; Skin; Surgery; Treatment Outcome; United States; Craniotomy; Inflammatory response; Local anesthetic infiltration; Scalp nerve block; Postcraniotomy pain
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-019-0760-4

The purpose of this study was to compare the effects of scalp nerve block (SNB) and local anesthetic infiltration (LA) with 0.75% ropivacaine on postoperative inflammatory response, intraoperative hemodynamic response, and postoperative pain control in patients undergoing craniotomy. Fifty-seven patients were admitted for elective craniotomy for surgical clipping of a cerebral aneurysm. They were randomly divided into three groups: Group S (SNB with 15 mL of 0.75% ropivacaine), group I (LA with 15 mL of 0.75% ropivacaine) and group C (that only received routine intravenous analgesia). Pro-inflammatory cytokine levels in plasma for 72 h postoperatively, hemodynamic response to skin incision, and postoperative pain intensity were measured. The SNB with 0.75% ropivacaine not only decreased IL-6 levels in plasma 6 h after craniotomy but also decreased plasma CRP levels and increased plasma IL-10 levels 12 and 24 h after surgery compared to LA and routine analgesia. There were significant increases in mean arterial pressure 2 and 5 mins after the incision and during dura opening in Groups I and C compared with Group S. Group S had lower postoperative pain intensity, longer duration before the first dose of oxycodone, less consumption of oxycodone and lower incidence of PONV through 48 h postoperatively than Groups I and C. Preoperative SNB attenuated inflammatory response to craniotomy for cerebral aneurysms, blunted the hemodynamic response to scalp incision, and controlled postoperative pain better than LA or routine analgesia. Clinicaltrials.gov NCT03073889 (PI:Xi Yang; date of registration:08/03/2017).