Effect of skin infiltration with ropivacaine on postoperative pain in patients undergoing craniotomy

Hongyu Zhou, Mengchan Ou, Yaoxin Yang, Qian Ruan, Yan Pan, Yu Li, Hongyu Zhou, Mengchan Ou, Yaoxin Yang, Qian Ruan, Yan Pan, Yu Li

Abstract

Background: Local anesthetic infiltration has been used to manage postoperative pain in various surgeries. The present study was aimed to investigate the effect of skin infiltration with 0.5 % ropivacaine on postoperative pain in patients undergoing craniotomy.

Methods: One hundred and six patients with ASA I/II scheduled to undergo elective craniotomy were enrolled during March to November in 2015 in this prospective, randomized, placebo-controlled, double-blind study. After the anesthesia induction, skin along the incision was infiltrated with 0.5 % ropicavaine (group R, n = 53) or 0.9 % normal saline (group C, n = 53), respectively. Morphine was used as rescue analgesic postoperatively. Morphine consumption during the first 24 postoperative hours was recorded as the primary outcome, and the time to first rescue requirement was also recorded. Pain was assessed at 2, 4, 8, 24 h, 7 days, 3 months after surgery by visual analog scale (VAS). Heart rate and mean arterial pressure were recorded before anesthesia induction (T1), after anesthesia induction (T2), after scalp infiltration (T3), during skull drilling (T4), mater cutting (T5) and skin closure (T6).

Results: Morphine consumption during the first 24 postoperative hours was significantly higher in group C than in group R (13.36 [6.5, 20] vs. 6.3 [0, 10] mg, P < 0.05). The first time of patients needed rescue analgesic was prolonged in group R as compared with group C (6.16 [3.4, 8.0] vs. 3.87 [2.3, 4] h, P < 0.05). Postoperative VAS and hemodynamic signs during the first 24 h showed no significant difference in two groups. The incidence of persistent pain on 7 days and 3 months postoperatively had no significant differences between two groups. Besides one patient (2 %) enduring moderate pain (VAS 4-7) in group C, the number of patients suffering from mild pain (VAS 1-3) was 17 (33.3 %) in group R and 17 (34 %) in group C 3 months after surgery.

Conclusion: The results suggest 0.5 % ropivacaine scalp infiltration before skin incision has favorable analgesic effect in reducing morphine consumption and prolong the time of first rescue analgesic requirement after surgery. Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn/) registration number: ChiCTR-IPR-14005717.

Keywords: Craniotomy; Postoperative pain; Ropivacaine; Scalp infiltration.

Figures

Fig. 1
Fig. 1
Flow of patients through testing and follow-up
Fig. 2
Fig. 2
Comparison of morphine consumption during the first 24 postoperative hours. Group C control group, Group R ropivacaine group. *P < 0.05 versus control group
Fig. 3
Fig. 3
Comparison of the first time patients requested rescue analgesia. Group C control group, Group R ropivacaine group. *P < 0.05 versus control group
Fig. 4
Fig. 4
Comparison of sufentanil and remifentanil consumptions during the surgery. Group C control group, Group R ropivacaine group
Fig. 5
Fig. 5
Comparison of VAS scores in both the groups after surgery. Group C control group, Group R ropivacaine group
Fig. 6
Fig. 6
Comparison of HR and MAP changes during surgery. T1 before anaesthesia induction, T2 after anaesthesia induction, T3 after scalp infiltration, T4 during skull drilling, T5 dura mater cutting, T6 skin closure. Group C control group, Group R ropivacaine group
Fig. 7
Fig. 7
Comparison of HR and MAP changes after surgery. Group C control group, Group R ropivacaine group
Fig. 8
Fig. 8
Comparison of postoperative Ramsay scores in both the groups after surgery. Group C control group, Group R ropivacaine group

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