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Ultrasound-guided superficial cervical plexus block reduces opioid consumption in patients undergoing craniotomy via suboccipital retrosigmoid approach: a randomized controlled trial
  1. Min Zeng1,
  2. Ruowen Li1,
  3. Xin Xu1,
  4. Dexiang Wang1,
  5. Jia Dong1,
  6. Shu Li1,
  7. Ira S Kass2,
  8. Yuming Peng1 and
  9. Wang Jia3
  1. 1Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
  2. 2Anesthesiology and Physiology & Pharmacology Departments, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
  3. 3Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
  1. Correspondence to Dr Yuming Peng, Department of Anesthesiology, Capital Medical University, Beijing, China; florapym766{at}163.com

Abstract

Introduction The effectiveness of superficial cervical plexus block (SCPB) at decreasing opioid use and improving hemodynamic stability during suboccipital retrosigmoid craniotomy has not been established. The aim of this study is to evaluate the analgesic effect of preoperative ultrasound-guided SCPB for craniotomy via a suboccipital retrosigmoid approach.

Methods This was a prospective, single-center, randomized, double-blind, parallel-group controlled trial. One hundred and six adult patients undergoing suboccipital retrosigmoid craniotomy were randomly allocated into either the SCPB group (n=53) to receive 10 mL of 0.5% ropivacaine or the control group (n=53) to receive 0.9% normal saline injected into the superficial layer of prevertebral fascia guided by ultrasound. The primary outcome was the cumulative consumption of sufentanil with patient-controlled intravenous analgesia (PCIA) within 24 hours. Secondary outcomes included the overall perioperative consumption of opioids, the area under the curve of the pain score from 1 hour to 48 hours (AUC1–48), intraoperative hemodynamic parameters, and anesthesia depth.

Results The mean PCIA pump cumulative consumption of sufentanil in the first 24 hour postoperative period was significantly lowered by SCPB (5.0 µg vs 9.8 µg, 95% CI: −8.0 to –2.4; p=0.001). The total perioperative consumption of sufentanil (45.0 µg vs 54.5 µg, 95% CI: –14.8 to –4.1; p=0.001) was also significantly decreased by SCPB. The incidence of severe pain within 24 hours was decreased by SCPB (7.5% vs 26.4%, p=0.01). SCPB significantly decreased the AUC1–48 of the pain score. Intraoperative hemodynamic parameters and anesthesia depth were similar between groups (p>0.05).

Discussion SCPB provides effective analgesia in patients undergoing craniotomy and tumor resection via suboccipital retrosigmoid approach. SCPB demonstrates an opioid-sparing effect and allows for the maintenance hemodynamic stability at an appropriate depth of anesthesia.

Trial registration number NCT04036812.

  • analgesia
  • pain, postoperative
  • acute pain

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors YP: as a guarantor responsible for the overall content, study design and data analysis. MZ and RL: writing up of the first draft of the paper. XX, DW, and JD: patient recruitment and data collection. SL: analysis and interpretation of data. ISK and WJ: revising it critically for important intellectual content.

  • Funding This work was supported by the Ministry of Science and Technology of the People's Republic of China funding (2018YFC2001901), Beijing Municipal Science & Technology Commission (Z191100006619068), and Incubator Program (PX2018023) from Beijing Municipal Administration of Hospitals.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.