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.
Anesthesia, Local
/ methods
Anesthetics, Local
/ administration & dosage
Craniotomy
/ adverse effects
Female
Hemodynamics
/ drug effects
Humans
Inflammation Mediators
/ antagonists & inhibitors
Intracranial Aneurysm
/ blood
Male
Middle Aged
Nerve Block
/ methods
Pain Management
/ methods
Pain, Postoperative
/ blood
Scalp
/ drug effects
Treatment Outcome
Craniotomy
Inflammatory response
Local anesthetic infiltration
Postcraniotomy pain
Scalp nerve block
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
01 06 2019
01 06 2019
Historique:
received:
28
10
2018
accepted:
20
05
2019
entrez:
3
6
2019
pubmed:
4
6
2019
medline:
20
2
2020
Statut:
epublish
Résumé
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).
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
TRIAL REGISTRATION
Clinicaltrials.gov NCT03073889 (PI:Xi Yang; date of registration:08/03/2017).
Identifiants
pubmed: 31153358
doi: 10.1186/s12871-019-0760-4
pii: 10.1186/s12871-019-0760-4
pmc: PMC6545200
doi:
Substances chimiques
Anesthetics, Local
0
Inflammation Mediators
0
Banques de données
ClinicalTrials.gov
['NCT03073889']
Types de publication
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
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