Comparison of scalp nerve block and local infiltration of incision for intracranial aneurysm clipping under general anesthesia / 中华麻醉学杂志

ABSTRACT

Objective To compare the scalp nerve block versus local infiltration of incision for in-tracranial aneurysm clipping under general anesthesia. Methods Fifty-seven American Society of Anesthe-siologists physical statusⅠorⅡpatients of both sexes, aged 18-64 yr, scheduled for elective intracranial aneurysm clipping under general anesthesia, were divided into 3 groups ( n=19 each) using a random num-ber table method:control group ( group C) , scalp nerve block group ( group S) and local infiltration of in-cision group ( group I) . Anesthesia was induced by intravenously injecting propofol, sufentanil and cisatra-curium. Bilateral supraorbital nerve (2 ml), supratrochlear nerve (2 ml), zygomaticotemporal nerve (2 ml), auriculotemporal nerve (2 ml), greater occipital nerve (3 ml), lesser occipital nerve (3 ml) and the third occipital nerve ( 1 ml) blocks were performed with 0. 75％ ropivacaine after tracheal intubation in group B. Local infiltration of incision was carried out with 0. 75％ ropivacaine 15 ml in group I. Anesthesia was maintained by intravenously infusing propofol and remifentanil to maintain bispectral index value at 40-60. The fluctuation range of mean arterial pressure and heart rate was not more than 20％ of the baseline, and vasoactive agents were administered when necessary. Oxycodone 0. 1 mg∕kg was intravenously injected at 30 min before the end of surgery to perform preemptive analgesia. When visual analogue scale score>3 with-in 48 h after surgery, oxycodone 2 mg was intravenously injected as rescue analgesic, and administration was repeated when necessary ( at an interval>15 min) . The intraoperative consumption of propofol, remifen-tanil and vasoactive agents was recorded. Arterial blood samples were collected before anesthesia induction and at 3, 12, 24, 48 and 72 h after surgery for determination of serum interleukin-6 ( IL-6) , IL-10 and C-reactive protein ( CRP ) concentrations by enzyme-linked immunosorbent assay. The time of the first postoperative requirement for oxycodone and consumption of oxycodone within 48 h after surgery were recor-ded. The development of adverse reactions such as postoperative fever, nausea and vomiting, dizziness, respiratory depression, pruritus, local anesthetic intoxication, subcutaneous hematoma, and scalp infec-tion was also recorded. Results Compared with group C, the intraoperative consumption of remifentanil and requirement for nicardipine were significantly decreased, the concentration of serum IL-6 was decreased at 3 h after surgery, the concentration of serum CRP was decreased at 12 h after surgery, the concentration of serum IL-10 was increased at 12 and 24 h after surgery, the time of the first postoperative requirement for rescue analgesia was prolonged, the consumption of oxycodone was reduced, and the incidence of nausea and vomiting was decreased in group B, and the intraoperative consumption of remifentanil was significantly reduced in group I (P<0. 05). Compared with group I, the intraoperative consumption of remifentanil was significantly reduced, the requirement for nicardipine was decreased, the concentration of serum IL-6 was decreased at 3 h after surger-y, the concentration of serum CRP was decreased at 12 h after surgery, the concentration of serum IL-10 was in-creased at 12 and 24 h after surgery, the time of the first postoperative requirement for rescue analgesia was pro-longed, the consumption of oxycodone was reduced, and the incidence of nausea and vomiting was decreased in group B (P<0. 05). Conclusion Compared with local infiltration of incision, scalp nerve block is helpful in carrying out anesthetic model of low-consumption opioids and in maintaining intraoperative hemodynamics stable and is more helpful in inhibiting perioperative inflammatory and pain responses when used for the patients under-going intracranial aneurysm clipping under general anesthesia.