Pain, Postoperative Clinical Trial
Official title:
The Scalp Block for Postoperative Pain Control in Craniosynostosis Surgery: a Case Control Study
Postoperative analgesia after corrective surgery of paediatric craniosynostosis is crucial in term of short and long-term outcomes. The objective of this observational case- control study was to evaluate the effectiveness of an analgesic technique based on the scalp block versus traditional pharmacological approach.
Several studies on craniosynostosis and the correlated risk factors have been published, the
majority of them focusing on the perioperative management of blood losses and avoidance of
haemorrhagic shock. Other issues related to anaesthetic management of the surgical correction
of craniosynostosis are metabolic and electrolyte disturbances.
Even if craniosynostosis surgery is an invasive procedure, there is a current misconception
that it would be associated with minimal pain, despite the extensive exhibition of the skull
and periostea dissection. The Literature about the assessment and management of postoperative
pain in this particular surgical setting is scarce. Assessment of pain in infants is
challenging, and often relies on clinical observation. To date, there are no evaluative and
therapeutic parameters globally accredited in this category of patients. The scalp nerve
block (SNB) is a regional anaesthetic technique, performed since several years in children
undergoing a variety of procedures, from neurosurgery to eye-nose-throat surgery.SNB has been
proposed as a complement to the routine craniosynostosis anaesthetic protocol, and should be
associated to a reduced need for opioids.
Thirteen patients, aged between 3 months and 2 years, undergoing cranioplasty for the
correction of craniosynostosis were subjected to SNB (Group SB) with Levobupivacaine 0.125%
(total dose 2 mg/kg), performed before awakening, in combination with intraoperative
intravenous acetaminophen (15 mg/kg if body weight >10Kg, 7 mg/kg if body weight < 10 kg).
The SNB procedure was performed using the modified Pinosky technique, with levobupivacaine
0,125%(10). A targeted infiltration of 0,75-2ml of local anaesthetic (LA) solution was done
at multiple sites with a 23G needle.
This Group of patients were compared with another group of 13 patients, derived from our
database, and treated with the traditional pharmacological approach given intraoperatively
(intravenous acetaminophen according to the body weight, plus intravenous tramadol 1 mg/kg).
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