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Abstract
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Background and Aims Scalp blocks have been described for analgesic management in craniotomies, traditionally performed using anatomical landmarks (ALGSB). In this study, we evaluated the effectiveness of ultrasound-guided scalp blocks (UGSB) compared to ALGSB in patients undergoing craniotomy.
Methods An observational prospective cohort study was conducted to compare postoperative analgesia in patients who received scalp blocks using anatomical landmarks versus ultrasound guidance (figure 1). Patients who underwent craniotomy and received total intravenous general anesthesia were included in the study. The primary outcome measured was adequate pain control, defined as a pain score of less than 4 on the numeric rating scale. Secondary outcomes included total postoperative opioid and non-opioid analgesic consumption.
Results A total of 111 patients were included in the analysis, with 59 and 52 patients receiving echo-guided and landmark-guided scalp blocks, respectively (table 1). Adequate pain control was achieved in 80% of the patients at 6 h, 71% at 12 h, and 70% at 24 h postoperatively. The echo-guided group demonstrated significantly better pain control at 24 h than the landmark-guided group (84.7% vs. 53.8%; p<0.01). Although both groups showed low opioid use in the first 24 h, the ultrasound-guided scalp blocks group exhibited a significant reduction in morphine consumption at 24 h compared to the landmark-guided group (3 vs. 10 mg; p<0.001)(table 2).
Conclusions Ultrasound-guided scalp blocks are an effective alternative to postoperative analgesia in patients undergoing craniotomy. Ultrasound guidance significantly improved postoperative pain control at 24 h and reduced opioid consumption compared to anatomical landmark-guided scalp blocks.