Pain is common in the first 2 days after major craniotomy. Inadequate analgesia may lead to an increased risk of postoperative complications. Most pain following craniotomy arises from the pericranial muscles and soft tissues of the scalp. Scalp nerve blocks with local anesthesia seem to provide effective, safe, however transient postoperative analgesia which does not seem to meet the requirements of craniotomy. Currently, peripheral dexamethasone has been observed to significantly prolong the duration of analgesia of nerve blocks (e.g., saphenous nerve block, adductor canal block, thoracic paravertebral block, brachial plexus nerve block). On the contrary, a study reported that perineural dexamethasone did not appear to prolong the analgesic time after supratentorial craniotomy. However, all patients in this study were given 24 mg of oral or intravenous dexamethasone regularly at least 7 days during the perioperative period, which possibly masked the role of single local low doses of perineural dexamethasone. Therefore, the analgesic effect of single dexamethasone for scalp nerve blocks without the backdrop of perioperative glucocorticoid deserves further clarification.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
156
The control group will receive scalp nerve blocks with 0.5% bupivacaine with epinephrine at 1:200,000, plus normal saline 1 ml. The anesthesiologist will perform scalp nerve blocks based on the group allocation 10 mins before the incision. Scalp nerve blocks will be performed according to the technique previously described by Pinosky et al.
The DEX4mg group will receive scalp nerve blocks with 0.5% bupivacaine with epinephrine at 1:200,000, plus 4 mg dexamethasone (1 ml). The anesthesiologist will perform scalp nerve blocks based on the group allocation 10 mins before the incision. Scalp nerve blocks will be performed according to the technique previously described by Pinosky et al.
Beijing Tiantan Hospital
Beijing, Beijing Municipality, China
The duration of analgesia
The time between the performance of the block and the administration of the first press the PCA demand button postoperatively.
Time frame: Within 48 hours after surgery
Sufentanil consumption
The cumulative amount of sufentanil consumption by PCA
Time frame: At 4, 12, 24 and 48 hours postoperatively
Numeric rating scale (NRS)
NRS: 11-point scale in which 0 = no pain to 10 = worst imaginable pain. An NRS score ≥4 will be considered significant or moderate pain. An NRS score ≥7 will be considered severe pain. Meanwhile, the localization of the site of the pain will also be documented.
Time frame: At 2, 4, 8, 12, 16, 20, 24, and 48 hours postoperatively
Glasgow Coma Scale (GCS)
A scale for measuring level of consciousness, in which scoring is determined by three factors: amount of eye opening, verbal responsiveness, and motor responsiveness.
Time frame: At 2, 4, 8, 12, 16, 20, 24, and 48 hours postoperatively
Postoperative nausea and vomiting (PONV)
Vomiting will be defined as the forceful expulsion of gastric contents, and nausea will be defined as an unpleasant sensation associated with the urge to vomit.
Time frame: Within 48 hours after surgery
Bradycardia
Bradycardia will be defined as HR\<60 beats/minute in at least two instances more than 5 minutes apart.
Time frame: Within 48 hours after surgery
Hypotension
Hypotension will be defined as any of the following: systolic BP \<90 mm Hg for 5 minutes or a 35% decrease in mean arterial blood pressure.
Time frame: Within 48 hours after surgery
Emergence delirium
Emergence delirium will be assessed by the Sedation Agitation Scale (SAS), a 7-point scale on which a higher score represents greater agitation.
Time frame: Within 48 hours after surgery
The length of stay (LOS)
The LOS will be defined as the number of nights spent in the hospital after surgery.
Time frame: About at 2 weeks after surgery
Patient satisfaction score (PSS)
PSS: 0 for unsatisfactory to 10 for very satisfactory.
Time frame: At 2, 4, 8, 12, 16, 20, 24, and 48 hours postoperatively
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