Journal Article

Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration

Tunali, Yusuf, Dilmen, Ozlem Korkmaz, Vehid, Hayriye, Ibısoglu, Lutfiye Serap, Akcil, Eren Fatma

2017

Overview

•The scalp block reduces hemodynamic response to pin head holder application in infratentorial craniotomies.•The scalp block and local anesthetic infiltration both reduce hemodynamic response to skin incision.•The scalp block also reduces postcraniotomy pain intensity. The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h. This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared. The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period. The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.

• Publisher: Elsevier B.V,Elsevier Limited
• Subject: Adult / Analgesics / Analgesics, Opioid - therapeutic use / Anesthesia / Anesthesia, Local - methods / Anesthesia, Local - standards / Anesthetics, Local - administration & dosage / Anesthetics, Local - pharmacology / Body mass index / Bupivacaine / Bupivacaine - administration & dosage / Bupivacaine - pharmacology / Cardiovascular disease / Craniotomy - methods / Craniotomy - standards / Female / Funding / Hemodynamics - drug effects / Humans / Hypertension / Infratentorial craniotomy / Local anesthetic infiltration / Male / Medical personnel / Middle Aged / Morphine - therapeutic use / Narcotics / Nerve Block - methods / Nerve Block - standards / Neurology / Neurosurgery / Opioid related side effects / Outcome Assessment (Health Care) / Pain / Pain, Postoperative - diagnosis / Pain, Postoperative - drug therapy / Patients / Postcraniotomy pain / Postoperative period / Scalp - drug effects / Scalp - innervation / Scalp - surgery / Scalp block / Skin / Surgery