Superficial cervical plexus block for transitional analgesia in infratentorial and occipital craniotomy: a randomized trial.
BACKGROUND
In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanil-based anesthesia for infratentorial or occipital craniotomy.


METHODS
In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mg·kg⁻¹ iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine.


RESULTS
Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups.


CONCLUSIONS
Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies.
Girard
Francois
F
Department of Anesthesia, Centre Hospitalier Universitaire de Montréal, Hôpital Notre-Dame, QC, Canada. francois.girard.chum@ssss.gouv.qc.ca
Quentin
Charlotte
C
Charbonneau
Sonia
S
Ayoub
Christian
C
Boudreault
Daniel
D
Chouinard
Philippe
P
Ruel
Monique
M
Moumdjian
Robert
R
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D002572:Cervical Plexus; D003061:Codeine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003399:Craniotomy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil; D013997:Time Factors
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D009020:Morphine; D008012:Lidocaine; D000077208:Remifentanil; D003061:Codeine; D002045:Bupivacaine