Scalp Block Decreases Pain and Side Effects

Study Overview
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Brief Summary
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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
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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).

Official Title
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The Scalp Block for Postoperative Pain Control in Craniosynostosis Surgery: a Case Control Study

Conditions
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Craniosynostoses, Pain, Postoperative

Intervention / Treatment
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* Other: scalp block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients undergoing cranioplasty for the correction of craniosynostosis Exclusion Criteria: allergies to local anesthetics and/or analgesics specific drug therapies (pain relievers, sedatives and/or epileptic) denied consent to the study; development of postoperative intracranical bleeding and/or gastrointestinal bleeding need of nasogastric tube development of gastrointestinal infections.

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 2 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group SB<br>Scalp block performed with Levobupivacaine 0.125% (total dose 2 mg/kg) in combination with intraoperative intravenous acetaminophen (15 mg/kg if body weight >10Kg, 7 mg/kg if body weight < 10 kg). | Other: scalp block<br>* intravenous acetaminophen according to the body weight, plus intravenous tramadol 1 mg/kg)<br>* Other names: intravenous pharmacological approach;|
| Group ST<br>intravenous acetaminophen according to the body weight, plus intravenous tramadol 1 mg/kg | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| pain intensity | Objective Pain Score incorporates four pain behaviors (crying, movement, agitation, and verbalization) and was evaluated at following times: 30 minutes after extubation (T0) 2 hours after extubation (T1) 4 hours after extubation (T2) 8 hours after extubation (T3) at discharge from Pediatric Intensive Care Unit (T4). at in the Neurosurgical ward OPS was assessed every eight hours, until the fifth day of hospitalization. | OPS was assessed until the fifth day of hospitalization. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| resumption of oral nutrition | evaluation of post-operative feeding recovery time | first postoperative day |