Résumé
Objective To observe the effect of scalp nerve block ( SNB ) with ropivacaine hydrochloride at different time points on pain management after craniotomy. Methods Ninety patients undergoing craniotomy were randomly divided into 3 groups:group A, SNB conducted before surgery;group B, SNB conducted after surgery;group C, SNB conducted both before and after surgery, with 0. 5% of ropivacaine hydrochloride in each group. All patients received the same general anesthesia and diclofenac sodium were administered rectally as rescue analgesics. Sites and duration of surgeries, end-tidal sevoflurane concentration during incision, HR and SBP levels during the course of surgery and postoperative period, the VAS scores, GCS and Ramsay scores at 0. 5, 2, 4, 6, 12, 24, 48 h postoperatively, time of the first rescue appication analgesics and total consumption of rescue analgesics, the adverse effects, awareness under anesthesia were analyzed respectively, as well as local anesthesia relevant adverse events and time of wound healing. Results The end-tidal sevoflurane concentration was significantly decreased in group B (3. 19±0. 36)% as compared with group A (1. 81±0. 24)% and C (1. 77±0. 33)% (P0. 05);Compared with group A (600 mg), the consumption of rescue analgesics of group B (300 mg) and C (250 mg) were statistically lower (P0. 05);The relevant side effects were not different statistically, and there were no patients suffering from obvious awareness under anesthesia, pruritus, respiratory depression or local anesthesia relevant adverse effects. Conclusion SNB conducted before surgery can decrease the consumption of sevoflurane during incision, but has limited analgesic effects postoperatively. SNB conducted after surgery may provide transitional analgesia for neurosurgical patients undergoing craniotomy, while SNB conducted both before and after surgery does not show significantly longer analgesic time in postoperative pain management.