Effect of scalp nerve block with ropivacaine on interleukin-1β, critical-care pain observation tool (CPOT), and fentanyl dose in elective craniotomy patients

Background: Considering that there is a gap in information regarding the effectiveness of Scalp Nerve Block (SNB) in post-craniotomy patients in reducing pain and inflammation, this study aims to examine the effectiveness of SNB in craniotomy patients through two variables, namely IL-1β and CPOT. In addition, this study also analyzed the dose of fentanyl in patients given SNB. Methods: This research is a prospective experimental randomized control trial (RCT) double-blind pre-post control group design study. A total of 40 patients underwent elective craniotomy at Dr. Soetomo General Hospital during October – November 2023. IL-1β as an inflammatory parameter was measured at post-induction, 4 hours post-incision, and 24 hours post-incision. CPOT score and fentanyl dose were measured up to 24 hours post-operatively. Results: The results of the comparison test for IL-1β levels at 4 hours post-incision in the SNB and non-SNB groups were significantly different (p<0.01). The delta levels of IL-1β post-induction and 4 hours post-incision were significantly different (p<0.05). However, there was no significant difference in IL-1β levels 24 hours post-incision or in the delta of IL-1β levels post-induction and 24 hours post-incision. In the non-SNB group, the results of the comparison test for the movement of IL-1β levels were significantly different (p<0.001). The comparison test of post-craniotomy CPOT scores in the SNB group with the non-SNB group at 4 hours and 8 hours was significantly different (p<0.05). The comparative test of fentanyl use during surgery up to 24 hours after craniotomy between the SNB group and the non-SNB group was significantly different (p<0.05). Conclusion: SNB with ropivacaine was effective in suppressing IL-1β levels in craniotomy up to 4 hours post-incision. SNB can also reduce post-craniotomy pain by reducing the CPOT score, as well as reducing the dose of fentanyl up to 24 hours after craniotomy.