Effectiveness of Scalp Nerves Block in Reducing the Immediate Postoperative Pain in Patients Undergoing Craniotomy in Elective Neurosurgical Procedures

Abstract

Objective: To determine the usefulness of regional scalp block in controlling pain after craniotomy.

Methodology: This prospective, randomized, double-blind, placebo-controlled study was conducted at the Pakistan Institute of Health Sciences, Islamabad from November 2021 to April 2022. Adult patients aged 18 to 65 years, scheduled for elective craniotomy for neurosurgical procedures with an American Society of Anesthesiologists (ASA) physical status of I or II, of either gender, were included. Patients underwent craniotomy for their respective lesions. Patients were randomized into two groups: one receiving a regional scalp nerve block of 0.5% bupivacaine with 1:100,000 epinephrine after general anesthesia, and the other undergoing general anesthesia as a placebo. Pain intensity was assessed using the Visual Analog Scale (VAS) pain score at baseline (preoperatively), at 1 hour postoperatively, and at 6 hours postoperatively.

Results: The mean age of patients in the treatment group was 43.14 years, while in the control group, it was 42.55 years. The treatment group had 26 males (54.2%) and 22 females (45.8%), while the control group had 25 males (52.1%) and 23 females (47.9%). There was no significant difference in the VAS score preoperatively (p > 0.05). Patients undergoing surgeries lasting less than 3 hours showed that the treatment group had a significantly lower mean VAS score of 3.08 at 1 hour compared to the control group's score of 5.11 (p = 0.027), while at the 6-hour post-surgery it was insignificant (p = 0.844). For surgeries lasting more than 3 hours, the treatment group had a significantly lower mean VAS score at 1 hour and at 6 hours post-surgery compared to the control group (p < 0.05). There were no overall complications associated with the subcutaneous injection of epinephrine and bupivacaine in blocking the scalp nerves.

Conclusion: The administration of scalp nerve blocks using bupivacaine and epinephrine prior to surgical incisions has demonstrated notable advantages in terms of postoperative pain management. Such nerve blocks can offer superior postoperative analgesia compared to the control group.