Effectiveness of Pre-Emptive Incision-Site Infiltration with Ropivacaine Combined with Triamcinolone Acetonide versus...

Local anesthetic incision-site infiltration (ISI) effectively eases post-craniotomy pain; however, its short duration limits sustained analgesia. This study aimed to assess the efficacy and safety of ropivacaine combined with triamcinolone acetonide along with ropivacaine alone via ISI to manage postoperative pain in adult craniotomy patients.

This prospective, randomized, open-label, controlled trial enrolled 110 patients (aged 18~65 years; American Society of Anesthesiologists Physical Status, I~III) scheduled for elective craniotomies. Patients were randomly allocated to two distinct groups: the treatment group received 0.5% ropivacaine combined with triamcinolone acetonide for ISI (n = 55) and the control group received 0.5% ropivacaine alone (n = 55). The primary outcome was sufentanil consumption (μg) via patient-controlled analgesia (PCA) within 48 h post-surgery using the intention-to-treat (ITT) principle and per-protocol (PP) analyses.

Within 48 hours post-surgery, the treatment group showed significantly lower cumulative sufentanil consumption than control group (8.4 ± 5.2 μg vs 32.7 ± 12.2 μg; mean difference: -24.3, 95% confidence interval -27.8 to -20.7; p < 0.001). The estimated median time to the first PCA-administered administration was 30 h in the treatment group versus 12 h in the control group (hazard ratio: 0.11, 95% CI: 0.07 to 0.18; log-rank p < 0.0001). A statistically significant decrease in numerical rating scale (NRS) pain scores was observed in the treatment group compared with the control group at all postoperative time points (2h to 1 month; p < 0.001 for all comparisons). No adverse events (AEs) occurred in either group during the study period.

Compared with ropivacaine alone, the addition of triamcinolone acetonide for ISI was associated with improved postoperative analgesia and reduced sufentanil consumption in adults who underwent craniotomy. Moreover, the combination was linked to a lower incidence of postoperative nausea and vomiting (PONV), with no reported severe AEs.