Preemptive Scalp Infiltration with 0.5% Ropivacaine and 1% Lidocaine Reduces Postoperative Pain after Craniotomy

【作者】 李丽；

【机构】 天津市人民医院；

【摘要】 Recent studies reported that 40%84%patients suffered moderate to excruciating pain which maximum occurred during the first 12 h after surgery.Under treatment of postoperative pain after craniotomy may cause a series of adverse events,such as hypertension and postoperative intracerebral hemorrhage that could negatively influence the final results.Traditionally using narcotics can induce moderate-to-high risk of postoperative nausea and vomiting(PONV) and consequences of analgesie-related side-effects post craniotomy.Scalp infiltration with local anesthetic or regional anesthesia that is equally effective or superior to systemic drugs has been preferable to relieve postoperative pain after craniotomy.12 Several clinical studies have shown that scalp infiltration with bupivacaine or ropivacaine decreased the incidence and severity of postoperative pain,but they usually applicate local anesthetic before skin closure.Preemptive regional analgesia prior to surgical trauma theoretically achieves peripheral blockage of pain stimuli,which is more advantageous than treating pain after it occurs.Furthermore,it prevents the establishment of central hypersensitization by analgesic intervention.Pretraumatic versus posttraumatic infiltration with the purpose of pain prevention has not been addressed after craniotomy on adults.The aim of this study was to compare the analgesic efficacy of preincisional and postincisional scalp infiltrations with 1%lidocaine and 0.5%ropivacaine on postoperative pain after craniotomy.In order to reduce the consequences of narcotic-related side-effects and provide effective analgesia after craniotomy,we conducted a randomized trial to compare the analgesic efficacy of preemptive scalp infiltrations with 1%lidocaine and 0.5%ropivacaine on the postoperative pain.Method:Sixty adult patients scheduled for craniotomy were enrolled.A solution contained 0.5%,ropivacaine and 1%lidocaine(40 mL) was prepared.In group A,local anesthetic was injected throughout the entire thickness of the scalp before skin incision.In group B,it was injected before skin closure.Additional intravenous injection and patient-controlled analgesia with morphine was used to control postoperative pain if the verbal numerical rating scale > 4.Cumulative morphine consumption;numerical rating scale of pain at 1,2,4,6,8,12,and 24 h;postoperative nausea,vomiting,and respiratory depression,were recorded for 24 h after the operation.Results:Postoperative pain scores were lower in group A than in group B within the first 6 h after surgery.Mean time to demand for postoperative analgesic was statistically(p < 0.001) delayed in group A 300(240,360) min compared to group B 150(105,200) min.Ten patients in group A received morphine analgesia was half less than 21 patients in group B(P < 0.006).The median morphine consumption in 24 h after operation in group A 10.5(8,15) mg was less than that in group B 28(22.5,30.5) mg(P < 0.001).Conclusions:Preemptive scalp infiltration with 0.5%ropivacaine and 1%lidocaine provides effective postoperative analgesia after craniotomy.更多还原

【Abstract】 Recent studies reported that 40%84%patients suffered moderate to excruciating pain which maximum occurred during the first 12 h after surgery.Under treatment of postoperative pain after craniotomy may cause a series of adverse events,such as hypertension and postoperative intracerebral hemorrhage that could negatively influence the final results.Traditionally using narcotics can induce moderate-to-high risk of postoperative nausea and vomiting(PONV) and consequences of analgesie-related side-effects post craniotomy.Scalp infiltration with local anesthetic or regional anesthesia that is equally effective or superior to systemic drugs has been preferable to relieve postoperative pain after craniotomy.12 Several clinical studies have shown that scalp infiltration with bupivacaine or ropivacaine decreased the incidence and severity of postoperative pain,but they usually applicate local anesthetic before skin closure.Preemptive regional analgesia prior to surgical trauma theoretically achieves peripheral blockage of pain stimuli,which is more advantageous than treating pain after it occurs.Furthermore,it prevents the establishment of central hypersensitization by analgesic intervention.Pretraumatic versus posttraumatic infiltration with the purpose of pain prevention has not been addressed after craniotomy on adults.The aim of this study was to compare the analgesic efficacy of preincisional and postincisional scalp infiltrations with 1%lidocaine and 0.5%ropivacaine on postoperative pain after craniotomy.In order to reduce the consequences of narcotic-related side-effects and provide effective analgesia after craniotomy,we conducted a randomized trial to compare the analgesic efficacy of preemptive scalp infiltrations with 1%lidocaine and 0.5%ropivacaine on the postoperative pain.Method:Sixty adult patients scheduled for craniotomy were enrolled.A solution contained 0.5%,ropivacaine and 1%lidocaine(40 mL) was prepared.In group A,local anesthetic was injected throughout the entire thickness of the scalp before skin incision.In group B,it was injected before skin closure.Additional intravenous injection and patient-controlled analgesia with morphine was used to control postoperative pain if the verbal numerical rating scale > 4.Cumulative morphine consumption;numerical rating scale of pain at 1,2,4,6,8,12,and 24 h;postoperative nausea,vomiting,and respiratory depression,were recorded for 24 h after the operation.Results:Postoperative pain scores were lower in group A than in group B within the first 6 h after surgery.Mean time to demand for postoperative analgesic was statistically(p < 0.001) delayed in group A 300(240,360) min compared to group B 150(105,200) min.Ten patients in group A received morphine analgesia was half less than 21 patients in group B(P < 0.006).The median morphine consumption in 24 h after operation in group A 10.5(8,15) mg was less than that in group B 28(22.5,30.5) mg(P < 0.001).Conclusions:Preemptive scalp infiltration with 0.5%ropivacaine and 1%lidocaine provides effective postoperative analgesia after craniotomy.更多还原