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

Abstract

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).

Keywords: Craniotomy; Inflammatory response; Local anesthetic infiltration; Postcraniotomy pain; Scalp nerve block.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

CONSORT flow diagram

Fig. 2

Concentrations of a C-reactive protein (CRP), b interleukin-6 (IL-6), and c interleukin-10 (IL-10) preoperatively (Pre-op) and 6, 12, 24, 48 and 72 h postoperatively in the three groups studied. Group C: control group, Group I: local anesthetic infiltration group, Group S: scalp nerve block group. *P < 0.05, compared to Group C, #P < 0.001, compared to Group I

Fig. 3

Comparison of HR and MAP changes during surgery. T1: before anesthesia induction, T2: 5 mins after induction, T3: 5 mins after skin incision, T4: 2 mins after the incision, T5: 5 mins after the incision, T6: during dura opening, and T7: the end of the surgery. Group C: control group, Group I: local anesthetic infiltration group, Group S: scalp nerve block group. #P < 0.05, for Group C compared with Groups I and S, +P < 0.001 for Groups I and C compared with Group S

Fig. 4

Comparison of VAS scores postoperatively for all three groups. Group C: control group, Group I: local anesthetic infiltration group, Group S: scalp nerve block group. #P < 0.05, Compared to Group C, *P < 0.001 for Group S compared with Groups I and C

Fig. 5

Comparison of a first patient request for rescue analgesia and b oxycodone consumption during the first 48 postoperative hrs. Group C: control group, Group I: local anesthetic infiltration group, Group S: scalp nerve block group. *P < 0.01 for Group C compared with Groups I and S, #P < 0.05 for Group I compared with Group S, +P < 0.001 for Group S compared with Groups C and I