Analgesic Efficacy and Safety of Ultrasound Guided Scalp Nerve Blocks in Supratentorial Craniotomies: A Randomized Controlled Trial

Abstract Background Multimodal analgesia is considered the cornerstone in controlling intraoperative and post operative pain in patients undergoing brain surgeries. A good control of strong noxious stimulations in supratentorial craniotomies allows a maintenance of an intraoperative hemodynamic stability and a post operative pain relief. Scalp sensory nerve block is considered one of the multimodal techniques to control intra and post operative pain, preventing the increase in intracranial pressure (ICP) and hypertension, which may be harmful, especially for patients with cerebral aneurysms. Also decreasing systemic analgesia and opioid that may alter conscious level of the patients allows better assessment and examination after surgery. Objective To compare the analgesic efficacy and safety of ultrasound use in performing scalp sensory nerve block compared to blind classical infiltration technique. Methods This randomized prospective controlled trial was conducted on 40 randomly chosen patients American Society of Anesthesiologists (ASA) class I or II scheduled for elective supratentorial craniotomy (supratentorial mass lesion or aneurysm clipping) under general anesthesia in Ain Shams University Hospitals after approval of the medical ethical committee. Results Intraoperative hemodynamic monitoring showed that there was a statistically significant decrease in HR, SINBP values in SBU group at time of skin incision (SI) compared to baseline values (before performing scalp block). Also Rates of both propofol and Fentanyl consumption showed a statistically significant decrease in SBU group at all time points of concern compared to baseline values. Postoperatively, patients received ultrasound guided scalp block had significantly lower pain scores after operation, with a significant increase in time for rescue analgesia and significant decrease in total amount of morphine needed in the first 24 hr post-operative compared to patients who received blind scalp block by local infiltration. Conclusion Ultrasound use in performing scalp block, is considered of choice for maintaining patient safety, intraoperative hemodynamic control and enhancing post-operative recovery.