Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration.
OBJECTIVE
The most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h.


METHODS
This prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared.


RESULTS
The scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period.


CONCLUSIONS
The scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.
University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: erenfat@yahoo.com.
Eren Fatma
EF
Akcil
University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: korkmazdilmen@gmail.com.
Ozlem Korkmaz
OK
Dilmen
University of Istanbul, Cerrahpasa School of Medicine, Department of Biostatistics, Turkey. Electronic address: ertem@istanbul.edu.tr.
Hayriye
H
Vehid
University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: serap_ibisoglu@hotmail.com.
Lutfiye Serap
LS
Ibısoglu
University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: ytunali@yahoo.com.
Yusuf
Y
Tunali
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000772:Anesthesia, Local / Q000379:methods / Q000592:standards*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D003399:Craniotomy / Q000379:methods / Q000592:standards*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D009407:Nerve Block / Q000379:methods / Q000592:standards*; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy; D012535:Scalp / Q000187:drug effects / Q000294:innervation* / Q000601:surgery
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine
Bupivacaine; Infratentorial craniotomy; Local anesthetic infiltration; Opioid related side effects; Postcraniotomy pain; Scalp block