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Effect of scalp nerve block on postcraniotomy analgesia in children: a randomized, controlled trial
Wei Xiong1, Yaxin Wang1, Lu Li1,2
1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Insights
Postoperative scalp nerve block (SNB) significantly reduces opioid use in children after craniotomy compared to preoperative SNB or no block. This effective analgesic strategy enhances pain management for pediatric neurosurgery patients.
Area of Science:
- Pediatric Anesthesiology
- Neurosurgery
- Pain Management
Background:
- Effective pain management is crucial for pediatric craniotomies.
- Scalp nerve block (SNB) is a potential analgesic intervention.
- Comparative benefits of preoperative vs. postoperative SNB are unclear.
Purpose of the Study:
- To investigate the analgesic effects of SNB in pediatric craniotomy patients.
- To compare the efficacy of preoperative versus postoperative SNB administration.
- To evaluate SNB's impact on postoperative pain and opioid consumption.
Main Methods:
- Randomized trial involving 180 children (1-12 years) undergoing elective craniotomy.
- Groups: preoperative SNB, postoperative SNB, and nonblocking control.
- Outcomes: sufentanil use, pain scores, rescue medicine, complications, hospitalization length.
Main Results:
- Postoperative SNB significantly reduced 24-hour sufentanil use compared to the nonblocking group (P < 0.001).
- Preoperative SNB also showed reduced sufentanil use versus controls at early time points (1-4h).
- Postoperative SNB demonstrated significantly lower sufentanil use than preoperative SNB within 24 hours (P=0.014).
Conclusions:
- Postoperative scalp nerve block is a highly effective analgesic intervention for pediatric craniotomy patients.
- It significantly reduces opioid requirements within 24 hours post-surgery.
- SNB offers a valuable strategy for optimizing pain management in this population.
Objective:
Effective postoperative pain management is critical for pediatric craniotomies. Scalp nerve block (SNB) interventions present a potential solution, yet their comparative benefits in preoperative and postoperative settings remain unclear. This study investigated the analgesic effects of SNB in pediatric craniotomy patients by comparing preoperative versus postoperative administration.
Methods:
This randomized trial included 180 children (1-12 years) who underwent elective craniotomy and were assigned to the preoperative, postoperative, or nonblocking control group. The outcomes included cumulative sufentanil use, pain scores (1, 2, 4, 24, 48 h postoperation), rescue medicine utilization, postoperative complications (24, 48 h), and hospitalization length. The primary outcome was total sufentanil use within 24 h postsurgery.
Results:
Total sufentanil use (µg·kg- 1) in the postoperative block group was significantly lower than that in the nonblocking control group at 1 h (P < 0.001, 95% CI [-0.024 to -0.006]), 2 h (P < 0.001, 95% CI [-0.054 to -0.020]), 4 h (P < 0.001, 95% CI [-0.089 to -0.032]), 24 h (P < 0.001, 95% CI [-0.192 to -0.047]), and 48 h (P = 0.010, 95% CI [-0.208 to -0.022]) postoperation. Additionally, sufentanil use in the preoperative block group was significantly lower than that in the nonblocking control group at 1 h (P = 0.004, 95% CI [-0.021 to -0.003]), 2 h (P < 0.001, 95% CI [-0.043 to -0.010]), and 4 h (P = 0.002, 95% CI [-0.069 to -0.013]). Within 24 h postoperation, the use of sufentanil in the postoperative block group was significantly lower than that in the preoperative block group (P = 0.014, 95% CI [-0.157 to -0.013]).
Conclusion:
Compared with preoperative SNB or nonblocking, postoperative SNB significantly reduces postoperative sufentanil use within 24 h for pediatric patients undergoing craniotomy, highlighting its potential as an effective analgesic intervention in this population.
Trial Registration:
The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800017386) on 27/07/2018, under the title "A study of scalp nerve block for neurosurgical analgesia in children with craniotomy."
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