title: Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine reduces postoperative pain after craniotomy.
abstract: BACKGROUND
  In order to reduce the consequences of narcotic-related side effects and provide effective analgesia after craniotomy, we conducted a randomized trial to compare the analgesic efficacy of preemptive scalp infiltrations with 1% lidocaine and 0.5% ropivacaine on the postoperative pain.
  
  
  METHODS
  Sixty adult patients scheduled for craniotomy were enrolled. A solution contained 0.5% ropivacaine and 1% lidocaine (40 ml) was prepared. In group A, local anesthetic was injected throughout the entire thickness of the scalp before skin incision. In group B, it was injected before skin closure. Additional intravenous injection and patient-controlled analgesia with morphine was used to control postoperative pain if the verbal numerical rating scale > 4. Cumulative morphine consumption; numerical rating scale of pain at 1, 2, 4, 6, 8, 12, and 24 h; postoperative nausea, vomiting, and respiratory depression, were recorded for 24 h after the operation.
  
  
  RESULTS
  Postoperative pain scores were lower in group A than in group B within the first 6 h after surgery. Mean time to demand for postoperative analgesic was statistically (p < 0.001) delayed in group A 300 (240, 360) min compared to group B 150 (105, 200) min. Ten patients in group A received morphine analgesia was half less than 21 patients in group B (p < 0.006). The median morphine consumption in 24 h after operation in group A 10.5 (8, 15) mg was less than that in group B 28 (22.5, 30.5) mg (p < 0.001).
  
  
  CONCLUSIONS
  Preemptive scalp infiltration with 0.5% ropivacaine and 1% lidocaine provides effective postoperative analgesia after craniotomy.
authors.affiliation: Departments of Neurological Surgery, Union Medical Center, Tianjin, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Song
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Pengtao
authors.initials: P
authors.lastname: Yu
authors.forename: Tao
authors.initials: T
authors.lastname: Gao
authors.forename: Kui
authors.initials: K
authors.lastname: Liu
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use*; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D003399:Craniotomy / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D000077212:Ropivacaine; D012535:Scalp / Q000187:drug effects*
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine; D008012:Lidocaine