Nursing experience of ventricular intracranial pressure monitoring after craniotomy / 中国中西医结合急救杂志

Objective To summarize the nursing experience of post-craniotomy patients using continuous intracranial pressure (ICP) monitoring. Methods Fifty post-craniotomy patients using ICP monitoring admitted to the Department of Neurosurgery of the First People's Hospital of Huzhou from March 2015 to March 2016 were enrolled. All patients were given the following nursing measures: maintaining the ICP monitoring device performance efficient and accurate, timely removing the factors associated with the increase of ICP and meanwhile, the dynamic changes of ICP and prognosis were observed. Results Fifty patients in this group all had elevated ICP, and the number of patients with mild, moderate, and severe ICP elevation was 26, 18, and 6 respectively. In this group of patients, 46 cases recovered well, 1 case was in a vegetative state, 2 cases gave up the treatment and 1 case died. None of the 50 patients had any complications and the detachment of tubing. The therapeutic program was adjusted in time based on ICP monitoring results. Conclusion Adopting correct intervention measures can effectively reduce the occurrence of complications, ensure that ICP monitoring can reflect the condition of ICP, and timely discover brain edema or recurrence of intracranial hematoma.

Combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infections after craniotomy / 中华危重病急救医学

Objective To explore the efficacy and safety of combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infection after craniotomy. Methods Clinical data of a total of 60 consecutive patients with intracranial infections after cranial operation admitted to Department of Neurosurgery of Nanfang Hospital of Southern Medical University from June 1st 2013 to June 1st 2015 were retrospectively analyzed. The patients were divided into two groups: intravenous injection only (n = 25) and combined intravenous and intrathecal injection (n = 35). In both groups of patients intravenously given vancomycin hydrochloride 500 kU every 6 hours as well as third or fourth generation of cephalosporins or meropenem. In combined intravenous and intrathecal injection group, in addition to 20 mg vancomycin was slowly injected via lumbar puncture after release of cerebrospinal fluid (CSF) once a day. The clinical efficacy and complications of the two groups were compared. Results The recovery rate in the combined intravenous and intrathecal injection group was significantly higher than that in the intravenous injection only group (94.3% vs. 76.0%, χ2 = 4.220, P = 0.040). Lowering of white blood cell count in combined intravenous and intrathecal injection group was significantly earlier than that of the intravenous injection only group (time to become normal: 8 days vs. 13 days). The time of recovery in combined intravenous and intrathecal injection group was significantly shorter than that of the intravenous injection only group (days: 9.9±0.7 vs. 13.4±1.1, t = -2.716, P = 0.009). There were 3 patients who experienced nerve root irritation symptoms in combined intravenous and intrathecal injection group. Symptomatic treatment was given and injection speed was slowed down for these patients. There were no severe complications, such as coma, epilepsy or death in both groups. Conclusion Combined intravenous and intrathecal injection of vancomycin could be a safe and effective therapy for intracranial infection after craniotomy.

Scar neuromas as triggers for headache after craniotomy: clinical evidence / Neuromas de cicatriz como gatilhos para cefaleia pós-craniotomia: evidência clínica

We present four cases of headache with variable intensity, located in close proximity to a craniotomy incision which was performed for non-traumatic reasons. Since manual palpation of the scar often triggers pain, and infiltration with local anesthetics reduce or abolish the pain in some patients, we suggest that neuromas or nerve entrapment in the scars, as a result of the surgery, are responsible for headaches. Although local infiltrations or nerve blocks are often used for diagnostic reasons, herein we consider that they are also of therapeutic value. We review the current known pathophysiology of post-craniotomy headaches and present a hypothesis suggesting a greater recognition of the potential contribution of neuroma formation in areas of scars tissue to contribute to this kind of headache.

Apresentamos quatro casos de cefaleia de variada intensidade, localizada junto à incisão de craniotomia, realizada por causas não traumáticas. Como a palpação manual da cicatriz desencadeava a dor e a infiltração local com anestésicos a reduzia ou abolia, apresentamos uma hipótese sugerindo a formação de neuromas de cicatriz na etiologia da dor. Sugerimos bloqueios anestésicos como ferramenta diagnóstica e terapêutica. Revisamos a fisiopatologia da cefaleia pós-craniotomia e apresentamos uma hipótese sugerindo a potencial contribuição da formação de neuromas de cicatriz na etiologia deste tipo de dor.

Effect of scalp nerve blocks on post-craniotomy pain in the patients undergoing craniotomy

BACKGROUND: Sympathetic stimulation associated with post-craniotomy pain might subsequently increase blood pressure resulting in postoperative complications. We studied whether scalp nerve blocks would reduce the severity of postoperative pain. METHODS: Thirty-two patients undergoing craniotomy were randomly allocated to either the ropivacaine group (n = 16) or the saline group (n = 16). After the skin closure, we carried out scalp nerve blocks with ropivacaine (0.75%) or saline (0.9%). Visual analog scale scores (VAS), mean arterial pressure, and heart rate were measured at 0.5, 1, 2, 4, 6, 12, 24, and 48 h after extubation. Tramadol 50 mg iv was used as rescue analgesic. The delay before administration of the first analgesic and cumulative dose of rescue analgesic for the first 48 h postoperatively were measured. RESULTS: The ropivacaine group had lower analgesic requirements than the saline group (P = 0.008). The delay before administration of the first analgesic was not different significantly between two groups. VAS was similar between the two groups at each time interval. Postoperative MAP and HR were not significantly different between two groups. VAS did not correlate with these hemodynamic variables. CONCLUSIONS: Although scalp nerve blocks with ropivacaine reduced the analgesic requirement, they did not provide the sufficient pain relief.