[Cranial nerve block with bupivacaine for postoperative analgesia following supratentorial craniotomy].
OBJECTIVE
To assess the effectiveness of analgesia by cranial nerve block with bupivacaine in the first 24 hours following elective supratentorial craniotomy.


METHODS
A prospective, randomized, double-blind study was performed in 30 patients who underwent craniotomy for excision of a tumor. The cranial nerve block was performed using saline (control group, n=15) or 0.25% bupivacaine with epinephrine at 1:200 000 (bupivacaine group, n=15). Morphine (2 mg, intravenous bolus) was used for rescue analgesia. Pain was assessed on a visual analog scale (VAS) at 2, 4, 8, 12, 16, and 24 hours following the cranial nerve block. The following data were recorded: time elapsed until appearance of pain, use of rescue analgesia, and incidence of adverse effects.


RESULTS
The use of morphine was significantly lower in the group of patients who received a cranial nerve block with bupivacaine than in the control group (mean [SD], 3.7 [1.6] mg vs 172 [2.5] mg). The mean time to the first requirement for rescue analgesia was longer in the bupivacaine group than in the control group (731 [247] minutes vs 80 [71] minutes). The VAS score during the first 16 hours was significantly lower in the bupivacaine group than in the control group. The incidence of nausea and vomiting was significantly higher in the control group (67% vs 13%).


CONCLUSIONS
Cranial nerve block with 0.25% bupivacaine following supratentorial craniotomy improves postoperative analgesia, reduces the requirement for morphine, and contributes to reducing nausea and vomiting.
Hernández Palazón
J
J
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia. joapal@ono.com
Doménech Asensi
P
P
Burguillos López
S
S
Pérez Bautista
F
F
Sánchez Amador
A
A
Clavel Claver
N
N
D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D003391:Cranial Nerves; D003399:Craniotomy / Q000009:adverse effects* / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies
D000779:Anesthetics, Local; D002045:Bupivacaine