Perioperative analgesic management using conventional versus regional nerve block in craniotomy surgeries in lower middle-income countries

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Objectives: This study’s primary objective was to assess the efficacy of systemic opioids with pre-incision bilateral scalp nerve block for supratentorial craniotomy pain via intraoperative hemodynamic variables at different intervals. The secondary objective was to assess the postoperative pain, rescue analgesia requirement, sedation, nausea and vomiting in first 24 hours of surgery. Methodology: This double-blinded randomized controlled trial, conducted at Aga Khan University Hospital, Karachi. The 62 adult patients (ASA I–III), recruited for elective supratentorial craniotomy via randomization into two groups (n=31/group). Group-M received intravenous morphine (0.1 mg/kg) at induction. Group-S received bilateral SNB with lidocaine, ropivacaine, adrenaline, and dexamethasone. The heart rate, systolic, diastolic, and mean arterial pressures were recorded at predefined intraoperative intervals. Postoperatively, both participants received PCIA morphine, and pain was assessed by visual analogue scale (VAS), along with sedation, nausea and vomiting incidences, which were recorded in first 24 hours at various intervals. Results: The demographic and surgical characteristics were insignificant in both groups (p<0.05). The hemodynamic variables such as heart rate was only increased on intense stimulation in both groups, relatively was higher in group-S compared to group-M. However, statistically it was insignificant. The systolic, diastolic, and mean arterial pressures were significantly stable in group-S, compared to Group-M, at various intraoperative intervals (p<0.05). The sedation, nausea and vomiting incidence were equivocal in both groups. The VAS pain score was significantly lower in group-S, compared to group-M, postoperatively from 2 to 24 hours. Conclusion: Pre-incisional scalp nerve block provides better attenuation of intraoperative noxious stimuli via hemodynamic control, and it shows superior postoperative analgesia, without risking the sedation, nausea and vomiting in supratentorial craniotomy surgeries.

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