ABSTRACT
We aimed to determine whether sphenopalatine ganglion block (SPGB) had a place as a treatment for headache, as well as its place as an anterior component of scalp block for supratentorial intracranial surgery. Using the keywords «sphenopalatine ganglion¼, «sphenopalatine ganglion block¼, «pain¼, «surgery¼ and «craniotomy¼ in PubMed and Google Scholar, we identified 14 relevant articles. The methods used to perform the block and the treatment of control groups differed between studies. The main outcomes studied were reduction in pain scores and hemodynamic variations during supratentorial intracranial surgery. All articles concluded that SPGB was equal or superior compared with other procedures. Although there are still several points to be studied, considering the ease of application, the low number of complications and the results of the studies, the use of SPGB for the headache treatment and in neurosurgery as an anterior component of scalp block seems appropriate.
Cette revue de la littérature narrative vise à déterminer la place du bloc du ganglion sphénopalatin (BGSP) comme traitement des céphalées ainsi que sa place comme composante antérieure du bloc de scalp pour la chirurgie intracrânienne supratentorielle. Avec les mots-clés «ganglion sphénopalatin¼, «bloc du ganglion sphénopalatin¼, «douleur¼, «chirurgie¼ et «crâniotomie dans PubMed et Google Scholar, nous avons identifié 14 articles pertinents. Les méthodes de réalisation du bloc ainsi que les traitements des groupes témoins différaient selon les études. Les résultats principaux étudiés étaient la réduction des scores de douleur ainsi que les variations hémodynamiques au cours de la chirurgie intracrânienne supratentorielle. Tous les articles ont conclu à la non-infériorité ou la supériorité du BGSP en comparaison à d'autres procédures. Bien que plusieurs points restent à étudier, compte tenu de la facilité d'application, du peu de complications et des résultats, l'utilisation du BGSP pour le traitement des céphalées et en neurochirurgie comme composante antérieure du bloc de scalp semble appropriée.
Subject(s)
Sphenopalatine Ganglion Block , Humans , Sphenopalatine Ganglion Block/methods , Headache/etiology , Headache/therapy , PainABSTRACT
BACKGROUND: The anesthetic management of supratentorial craniotomy (CR) necessitates tight intraoperative hemodynamic control. This type of surgery may also be associated with substantial postoperative pain. We aimed at evaluating the influence of regional scalp block (SB) on hemodynamic stability during the noxious events of supratentorial craniotomies and total intravenous anesthesia, its influence on intraoperative anesthetic agents' consumption, and its effect on postoperative pain control. METHODS: Sixty patients scheduled for elective CR were prospectively enrolled. Patient, anesthesiologist, and neurosurgeon were blind to the random performance of SB with either levobupivacaine 0.33% (intervention group [group SB], n = 30) or the same volume of saline (control group [group CO], placebo group, n = 30). General anesthesia was induced and maintained using target-controlled infusions of remifentanil and propofol that were adjusted according to hemodynamic parameters and state entropy of the electroencephalogram (SE), respectively. Mean arterial blood pressure (MAP), heart rate (HR), SE, and propofol and remifentanil effect-site concentrations (Ce) were recorded at the time of scalp block performance (Baseline), and 0, 1, 3, and 5 minutes after skull-pin fixation (SP), skin incision (SI), CR, and dura-mater incision (DM). Morphine consumption and postoperative pain intensity (0-10 visual analog scale [VAS]) were recorded 1, 3, 6, 24, and 48 hours after surgery. Propofol and remifentanil overall infusion rates were also recorded. Data were analyzed using 2-tailed Student unpaired t tests, 2-way mixed-design analysis of variance (ANOVA), and Tukey's honestly significant difference (HSD) tests for post hoc comparisons as appropriate. RESULTS: Demographics and length of anesthetic procedure of group CO and SB were comparable. SP, SI, and CR were associated with a significantly higher MAP in group CO than in group SB, at least at one of the time points of recording surrounding those noxious events. This was not the case at DM. Similarly, HR was significantly higher in group CO than in group SB during SP and SI, at least at 1 of the points of recording, but not during CR and DM. Propofol and remifentanil Ce and overall infusion rates were significantly higher in group CO than in group SB, except for propofol Ce during SP. Postoperative pain VAS and cumulative morphine consumption were significantly higher in group CO than in group SB. CONCLUSIONS: In supratentorial craniotomies, SB improves hemodynamic control during noxious events and provides adequate and prolonged postoperative pain control as compared to placebo.
