Craniotomy Surgery, Plexus Block;Analgesia;Neurosurgery, Regional Anaesthesia, Scalp Block
Conditions
Keywords
superficial cervical plexus block, supraorbital nerve block, scalp block, craniotomy, remifentanil, regional anesthesia
Brief summary
Perioperative pain management in craniotomy requires the administration of effective regional anesthetic techniques to reduce the use of systemic opioids and optimize hemodynamic control. Scalp block has been demonstrated to suppress hemodynamic response; however, its implementation generally involves a large number of injection points (six nerves that must be blocked bilaterally, resulting in a total of 12 injection points) and the possibility that not all nerve points are adequately blocked. Meanwhile, superficial cervical plexus and supraorbital block involves fewer injection points (two nerves to be blocked bilaterally, for a total of four injection points) with an analgesia area that may be sufficient to facilitate craniotomy surgery, including the insertion of Mayfield pins, consisting of only three pins, where the pin insertion area is not too large. The objective of this study is to compare the efficacy of combined superficial cervical plexus and supraorbital block with scalp block in reducing intraoperative opioid consumption and controlling hemodynamic response in craniotomy surgery.
Interventions
PROCEDURECombination of superficial cervical plexus block and supraorbital block
The combined anaesthesia technique involves the use of general anaesthesia and regional block in the superficial cervical plexus and supraorbital areas, with 6 ml of 0.25% bupivacaine injected into the superficial cervical plexus area and 2 ml into the supraorbital area.
PROCEDUREScalp block with bupivacaine alone
A combination anaesthesia technique is used that involves general anaesthesia and scalp block. Scalp block using 0.25% bupivacaine in the supraorbital area (2 ml), supratrochlear (2 ml), zygomaticotemporal (2 ml), auriculotemporal (2 ml), major occipital (2 ml) and minor occipital (2 ml).
Sponsors
Indonesia University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. The patient has been scheduled to undergo a craniotomy procedure that has been deemed medically necessary and electively scheduled. The aforementioned procedure will be performed under the administration of general anesthesia and the utilization of Mayfield pins. 2. Adult patients who have reached an age of 18 years and have not yet reached 65 years of age are included in this study. 3. Patients with ASA classification 1 - 3 4. The patient has expressed their willingness to participate in a research study and has provided their signature on an informed consent form.
Exclusion criteria
1. The patient has been diagnosed with an infection in the area where the block needle insertion is to be performed. 2. The subjects of this study were patients with a body mass index (BMI) greater than 30 kg/m2 who were classified as Grade II obese. 3. The patient is currently undergoing treatment with a beta-blocker. 4. Patients in whom intraoperative evoked potential monitoring is scheduled. 5. The patient is scheduled to undergo a total intravenous anesthesia technique 6. The history of an allergy to local anesthesia is presented before.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Remifentanil consumption for each step of surgery | intraoperative | The target effect of the highest dose of Remifentanil administered by total controlled infusion when there is an increase in MAP or heart rate by more than 20% of the initial value for 30 seconds during Mayfield pin placement, skin incision, periosteal manipulation, and skin suturing. |
| The total amount of Remifentanil administered during the operation | Intraoperative | The total amount of remifentanil that the medical team used during the surgery |
| The greatest alterations in mean arterial pressure (MAP) during the pinning procedure, followed by skin incision, periosteum manipulation, and skin suture. | Intraoperative | Changes in mean arterial pressure were measured at several points: 30 minutes after the block was administered; during pin insertion; during skin incision; during periosteal incision; and during skin suturing. |
| The greatest alteration in heart rate during the pinning procedure, followed by skin incision, periosteum manipulation, and skin suture. | Intraoperative | Changes in heart rate were measured at several points: 30 minutes after the block was administered; during pin insertion; during skin incision; during periosteal incision; and during skin suturing. |
Countries
Indonesia
Outcome results
None listed