Clinical Application of Scalp Nerve Block Combined with Sevoflurane in Craniotomy / 昆明医科大学学报

Objective To explore the application efficacy of scalp nerve block combined with sevoflurane in craniotomy.Methods Fifty-five patients undergoing craniotomy in pingdingshan second people's hospital of henan province from Mar 2013 to Mar 2015 were randomly divided into observation group (n =28) and control group (n =27).The scalp nerve block combined with sevoflurane was performed in observation group and the sevoflurane intravenous inhalational combined with sufentanil was performed in control group.The changes of MAP and HR were observed before induction,5min after induction,skin incision,break the meninges,operation end and 5rmin after catheter removal.The agitation scale after operation,anesthesia duration,awaking time and dosage of sufentanil were compared.Restults MAP and HR at skin incision,break the meninges,operation end and 5min after catheter removal in control group were significantly increased than those before operation,and significantly higher than those in observation group at same stage of operation,with statistically significance differences (P ＜0.05).The agitation scale of observation group was lower than that of control group,with statistically significance difference (P ＜0.05).There was no significance difference between two groups in anesthesia duration (P＞0.05),the awaking time in observation group was significantly shorter than that in control group and the dosage of sufentanil was significantly reduced in observation group (P＜0.05).Corclusion Scalp nerve block combined with sevoflurane used in craniotomy has advantages in stable vital signs,rapid awaking,less dosage of sufentanil and lower score of agitation,which is suitable for clinical application.

The role of group III metabotropic receptors on opioid tolerance

BACKGROUND: Prolonged exposure to morphine causes tolerance to morphine-induced antinociception, yet the mechanisms of such tolerance are not fully understood. Although group I and II metabolic glutamate receptors (mGluRs) are involved in the modulation of morphine tolerance, the role of the group III mGluRs has not been determined. Therefore, we examined the effect of a group III mGluRs agonist on the morphine tolerance in the spinal cord. METHODS: An intrathecal infusion of morphine (40 nmol/microl/h) for 5 days was done to examine the development of morphine tolerance in male Sprague-Dawley rats. Noxious radiant heat was applied to the hindpaw and we measured the thermal withdrawal latency. To clarify the role of the group III mGluRs, an intrathecal group III mGluRs agonist (ACPT-III) or saline was administered to the morphine tolerant rats and we observed the change of the thermal withdrawal latency at 15, 30, 60, 90 and 120 min after delivery of ACPT-III. RESULTS: A continuous intrathecal infusion of morphine significantly increased the thermal withdrawal latency, as compared with the saline infused rats on day 1, with a decline on day 3 and the increase of withdrawal latency totally disappeared on day 5 (tolerance). Intrathecal ACPT-III increased the thermal withdrawal latency in the morphine tolerance rats. CONCLUSIONS: These results suggest that the group III mGluRs may be involved in the suppression of tolerance to morphine-induced antinociception at the spinal level.

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.