Abstract
BackgroundLocal anesthetic infiltration has been used to manage postoperative pain in various surgeries. The present study was aimed to investigate the effect of skin infiltration with 0.5 % ropivacaine on postoperative pain in patients undergoing craniotomy.MethodsOne hundred and six patients with ASA I/II scheduled to undergo elective craniotomy were enrolled during March to November in 2015 in this prospective, randomized, placebo-controlled, double-blind study. After the anesthesia induction, skin along the incision was infiltrated with 0.5 % ropicavaine (group R, n = 53) or 0.9 % normal saline (group C, n = 53), respectively. Morphine was used as rescue analgesic postoperatively. Morphine consumption during the first 24 postoperative hours was recorded as the primary outcome, and the time to first rescue requirement was also recorded. Pain was assessed at 2, 4, 8, 24 h, 7 days, 3 months after surgery by visual analog scale (VAS). Heart rate and mean arterial pressure were recorded before anesthesia induction (T1), after anesthesia induction (T2), after scalp infiltration (T3), during skull drilling (T4), mater cutting (T5) and skin closure (T6).ResultsMorphine consumption during the first 24 postoperative hours was significantly higher in group C than in group R (13.36 [6.5, 20] vs. 6.3 [0, 10] mg, P < 0.05). The first time of patients needed rescue analgesic was prolonged in group R as compared with group C (6.16 [3.4, 8.0] vs. 3.87 [2.3, 4] h, P < 0.05). Postoperative VAS and hemodynamic signs during the first 24 h showed no significant difference in two groups. The incidence of persistent pain on 7 days and 3 months postoperatively had no significant differences between two groups. Besides one patient (2 %) enduring moderate pain (VAS 4–7) in group C, the number of patients suffering from mild pain (VAS 1–3) was 17 (33.3 %) in group R and 17 (34 %) in group C 3 months after surgery.ConclusionThe results suggest 0.5 % ropivacaine scalp infiltration before skin incision has favorable analgesic effect in reducing morphine consumption and prolong the time of first rescue analgesic requirement after surgery.Trial registration Chinese Clinical Trial Registry (http://www.chictr.org.cn/) registration number: ChiCTR-IPR-14005717
Highlights
Local anesthetic infiltration has been used to manage postoperative pain in various surgeries
The exclusion criteria included inability to understand and use the visual analogue scale (VAS), patients undergoing intervertebral anaesthesia and/or epidural analgesia, patients managed with postoperative patientcontrolled epidural analgesia or postoperative intravenous analgesia, inability to communicate because of impaired consciousness (Glasgow Coma Score less than 15), proven or suspected allergy to local anaesthetics, a previous scalp incision, and patients treated with opioids for more than 14 days in the last 3 months or nonopioid analgesics at a frequency greater than 5 times per week
The surgeries of seven patients were cancelled after randomisation, 13 patients were admitted to ICU for ventilation, 16 patients were aphasic or were incapable of communicating, and 12 patients used other analgesics rather than morphine for postoperative analgesia
Summary
Local anesthetic infiltration has been used to manage postoperative pain in various surgeries. The present study was aimed to investigate the effect of skin infiltration with 0.5 % ropivacaine on postoperative pain in patients undergoing craniotomy. Acute hypertension is deleterious for neurosurgical patients because it may translate into increasing intracranial pressure and increased risk of cerebral aneurysm rupture. This effect can result in haemorrhage, cerebral hernia or pulmonary oedema (Basali et al 2000), all of which are fatal complications. Effective perioperative pain management is highly demanded to prevent the acute hypertension-related morbidity in neurosurgical patients
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