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Ultrasound-guided Greater Occipital Nerve Block in Children Undergoing Posterior Fossa Craniotomy: A Randomized,
Heba Nassar1, Khaled Sarhan, Maha Gamil
1Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Insights
Ultrasound-guided greater occipital nerve (GON) block significantly reduces postoperative pain and analgesic needs in children after posterior fossa surgery. This technique offers improved pain management and hemodynamic stability compared to standard care.
Area of Science:
- Pediatric Anesthesiology
- Neurosurgery
- Pain Management
Background:
- Posterior fossa surgery in children frequently leads to severe postoperative pain.
- Effective pain management is crucial for recovery and patient well-being after such procedures.
Purpose of the Study:
- To evaluate the efficacy of ultrasound-guided greater occipital nerve (GON) block in managing postoperative pain.
- To assess the impact of GON block on hemodynamic stability in pediatric patients undergoing posterior fossa craniotomy.
Main Methods:
- A randomized controlled trial involving children aged 2-12 years undergoing posterior fossa craniotomy.
- Participants were assigned to either standard care or standard care plus bilateral ultrasound-guided GON block.
- Outcomes included pain scores, time to first analgesia, fentanyl consumption, hemodynamics, and nausea/vomiting incidence.
Main Results:
- The GON block group exhibited significantly lower pain scores at multiple postoperative time points (2-24 hours).
- Time to first analgesic request was substantially longer in the GON block group (13.4 hours vs. 1.8 hours).
- Intraoperative fentanyl consumption and systolic blood pressure were reduced in the GON block group, with no increase in nausea/vomiting or complications.
Conclusions:
- Ultrasound-guided GON block provides superior and longer-lasting postoperative analgesia in pediatric posterior fossa craniotomy.
- The procedure enhances hemodynamic profiles and is safe, with no reported nerve-block-related complications.
Background:
Posterior fossa surgery is commonly associated with severe postoperative pain. This study assessed the impact of ultrasound-guided greater occipital nerve (GON) block on postoperative pain and hemodynamic profiles in pediatric posterior fossa craniotomy.
Materials And Methods:
Children aged 2 to 12 years undergoing elective posterior fossa craniotomy with general anesthesia were randomly allocated to a control group receiving standard care (n=18) or a GON block group receiving standard care plus bilateral ultrasound-guided GON block (=17). Outcomes were postoperative pain assessed using the objective pain scale, time to first postoperative analgesia, intraoperative fentanyl consumption, perioperative blood pressure and heart rate, incidence of nausea and vomiting, and nerve-block-related complications.
Results:
Objective pain scale scores were lower in the GON block group than in the control group at 2, 4, 6, 8 (all P =0.0001), 12 ( P =0.001), 16 ( P =0.03), and 24-hour ( P =0.004) postoperatively. The time to first analgesic request was 13.4±7.4 hours in the GON block group and 1.8±1.5 hours in the control group ( P <0.001). Intraoperative fentanyl consumption was 2.68±0.53 μg/kg -1 in the GON block group and 4.1±0.53 μg/kg -1 in the control group ( P =0.0001). Systolic blood pressure was lower in the GON block group at several intraoperative and postoperative time points, whereas heart rate was similar in the two groups at most time points. The incidence of postoperative nausea and vomiting was similar between groups ( P =0.38), and there were no nerve-block-related complications.
Conclusions:
In children undergoing posterior fossa craniotomy, GON block was associated with superior quality and duration of postoperative analgesia and better hemodynamic profile compared with standard care.
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