Scalp Block Decreases Pain and Side Effects
Condition: Craniosynostoses; Pain, Postoperative
MeSH terms: Craniosynostoses; Pain, Postoperative
Study type: Observational

Summary: 
      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.
    

Detailed description: 
      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).
    

Intervention name(s): scalp block
Intervention type(s): Other
Intervention description(s): intravenous acetaminophen according to the body weight, plus intravenous tramadol 1 mg/kg)
Other intervention name(s): intravenous pharmacological approach
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        patients with aged between 3 months and 2 years, undergoing cranioplasty for the correction
        of craniosynostosis