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219 The challenge of opioid-free anesthesia in neurosurgery: an observational study
  1. R López Herrero,
  2. B Sánchez Quirós and
  3. D Velasco Villanueva
  1. Hospital Clínico Universitario, Valladolid, Spain


Background and Aims The use of opioids in the management of acute perioperative pain is very effective, but their use entails a series of adverse effects. Using OFA we avoid adverse effects. There are different studies (1) that indicate that the intra and postoperative use of opioids in patients with a tumor process could contribute to tumor progression.

Methods A retrospective observational study of patients over 18 years of age who were scheduled for elective craniectomy for a period of six months. This study was approved by the local Ethics Committee (IP 20-1802). Anesthesia was induced with propofol, midazolam, and rocuronium. Maintenance was established with propofol. We make a scalp block (frontal, auriculotemporal, zygomaticotemporal, occipital nerves) with 0,3% ropivacaine and 1% lidocaine, using 2,5 ml for each of the nerves. VAS values were recorded at the end of the intervention after waking up the patient and morphine doses required during the first 24 postoperative hours.

Results 46 patients were recruited, 58,7% men and 41,3% women, mean age 58,65%. 76% of the patients underwent supratentorial craniectomy and 24% underwent infratentorial craniectomy. VAS 0 after extubation in 100% of patients. 75% of the patients didn´t require postoperative morphine. 26% required postoperative morphine (mean dose of 4,1 mg in 24 hours). No patient presented complications secondary to the block.

Conclusions Although our study has limitations, there were no complications after the scalp block. We can conclude that due to the low rate of complications and the low postoperative consumption of opioids, we can use scalp block for neurosurgical.

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