Systematic Review and Meta-Analysis of Randomized Controlled Trials for Scalp Block in Craniotomy

Scalp block improves electrophysiological stability and patient cooperation during deep brain stimulation surgery

Deep Brain Stimulation (DBS) is a critical intervention for various neurological disorders. While effective, the traditional local infiltration anesthesia used in DBS surgeries often hinders electrophysiological recording quality and patient cooperativeness. The research aims to evaluate the impact of local infiltration versus scalp block anesthetic methods on electrophysiological signal quality and patient cooperativeness during DBS surgeries. This study involved patients who participated in an intraoperative task during the bilateral subthalamic nucleus DBS surgery for Parkinson's Disease between Jan 2020 and Dec 2022. Patients were either administered the traditional local infiltration anesthesia or the modified scalp block anesthesia. Intraoperative electrophysiological recording data and anesthetic data was collected. Spike sorting was performed to evaluate the recording stability. Patient cooperativeness and intraoperative experience was assessed and compared. The patients under scalp block anesthesia exhibited shorter pre-acquisition time, longer stable recording time, higher number of tasks per site, higher number of neurons recorded per task (all ps < 0.05). In behavior, patients under scalp block anesthesia showed higher accuracy in tasks (p < 0.05), while the response time was comparable. The overall satisfaction of anesthesia was also higher in scalp block, as revealed by the visual analogue scale, Likert scale and mean arterial pressure (all ps < 0.05). The modified scalp block anesthetic method offers considerable advantages over traditional local infiltration anesthesia in DBS surgeries. It helps to improve both patient comfort and cooperation during the surgery, and thereby enhancing the overall quality of neurological data and efficacy of DBS procedures.

Posterior scalp block with bupivacaine and dexmedetomidine for pain management in posterior fossa surgeries: a prospective, double blind randomized controlled trial

BACKGROUND

Pain management in posterior fossa surgeries poses significant challenges, with opioid-based approaches causing unwanted side effects. This study evaluates the efficacy of posterior scalp block using bupivacaine and dexmedetomidine compared to skin infiltration for managing perioperative pain.

METHODS

In this prospective, double-blind, randomized controlled trial, 34 adult patients undergoing elective posterior fossa surgeries were equally assigned to either posterior scalp block or skin infiltration groups. Outcomes measured included hemodynamic parameters, pain scores, opioid consumption, time to first analgesic, and sedation levels.

RESULTS

The posterior scalp block group showed significantly lower opioid consumption (211.47 ± 101.95 mcg vs 305.88 ± 117.10 mcg; p < 0.01) and pain scores (VAS 2.29 ± 0.9 vs 5.06 ± 1.3; p < 0.001) at 24 hours post-surgery. This group also demonstrated better hemodynamic stability and fewer rescue opioid requirements (9 vs 15 patients; p < 0.009).

CONCLUSIONS

Posterior scalp block with bupivacaine and dexmedetomidine significantly improves pain management, reduces opioid use, and provides better hemodynamic stability compared to skin infiltration in posterior fossa surgeries.

CLINICAL TRIAL REGISTRATION

CTRI/2023/07/0554959.

Anesthetic Management of Awake Craniotomy Versus Traditional Craniotomy at a Single Academic Center: A Retrospective Review

Awake craniotomies (AC) are an increasingly popular surgical technique used in medical institutions worldwide. This rise in adoption is largely due to improved patient outcomes and satisfaction. This procedure allows for real-time monitoring of neurological functions, which helps surgeons preserve critical cognitive, language, and motor abilities. As a result, patients tend to retain neurological functions closer to their baseline levels, highlighting the technique's advantages in modern neurosurgery. Neuromonitoring and brain mapping allow surgeons to perform resections more precisely in delicate anatomical areas. We developed and implemented a protocol for awake craniotomy procedures at the University of Mississippi Medical Center a few years ago. The purpose of this study was to assess and analyze the data between anesthetic management of awake craniotomy and traditional craniotomy (TC). We compared patient characteristics, anesthetic management, surgical duration, complications, opioid requirements, and length of hospital stay (LOS). Our results indicated a statistically significant reduction in the opioid requirement for patients in the awake craniotomy group with no difference in the overall length of stay.

Nerve Blocks for Craniotomy

PURPOSE OF REVIEW

Postcraniotomy headache (PCH) is a common adverse event and can lead to various complications and decreased quality of life.

RECENT FINDINGS

To reduce postcraniotomy pain and associated complications, a multimodal pain therapy including analgesics, analgesic adjuncts, and regional anesthesia is essential. The use of opioids should be minimized to facilitate prompt postoperative neurosurgical assessment. Here, we provide an update on the latest evidence regarding the role of scalp nerve blocks in the pain management of patients undergoing craniotomy procedure. Nerve blocks are effective in alleviating postoperative pain after craniotomy. Scalp blocks contribute to lower pain levels and less opioid consumption in the first 48 h following surgery. Moreover, there is a significant decrease in patients suffering from PONV among patients who receive scalp block.