Scalp Nerve Block, Local Anesthetic Infiltration, and Postoperative Pain After Craniotomy: A Systematic Review and Network Meta-analysis of Randomized Trials

医学 罗哌卡因 麻醉 随机对照试验 开颅术 局部麻醉剂 利多卡因 类阿片 荟萃分析 神经阻滞 羟考酮 布比卡因 舒芬太尼 外科 内科学 受体
作者
Mengqiang Luo,Xu Zhao,Meng Deng,Yue Hu,Xiaoyu Yang,Zubing Mei,Lingzhong Meng,Ying‐Wei Wang
出处
期刊:Journal of Neurosurgical Anesthesiology [Ovid Technologies (Wolters Kluwer)]
卷期号:35 (4): 361-374 被引量:8
标识
DOI:10.1097/ana.0000000000000868
摘要

The most efficacious methods for controlling postoperative pain in craniotomy remain unknown. A systematic review and network meta-analysis were performed to compare the efficacies of different strategies of scalp nerve block (SNB), scalp infiltration (SI), and control in patients undergoing craniotomy. MEDLINE, Embase, and CENTRAL databases were searched for randomized controlled trials. The primary outcome was postoperative 24-hour pain score, and the secondary outcome was opioid consumption within the first 24 hour after surgery. The effect was estimated using the between-group mean difference and ranked using the surface under the cumulative ranking curve (SUCRA) score. Twenty-four randomized trials were identified for inclusion. SNB using ropivacaine reduced postoperative 24-hour pain score when compared with control (mean difference [95% credible interval], –2.04 [–3.13, –0.94]; low quality), and when compared with SI using ropivacaine (–1.77 [–3.04, –0.51]; low quality) or bupivacaine (–1.96 [–3.65, –0.22]; low quality). SNB using ropivacaine was likely the most efficacious method for pain control (SUCRA, 91%), and also reduced opioid consumption within the first postoperative 24 hours as compared with control (mean difference [95% credible interval], –11.91 [–22.42, –1.4]; low quality). SNB using bupivacaine, lidocaine, and epinephrine combined, and SNB using ropivacaine, were likely the most efficacious methods for opioid consumption reduction (SUCRA, 88% and 80%, respectively). In summary, different methods of SNB / SI seem to have different efficacies after craniotomy. SNB using ropivacaine may be superior to other methods for postcraniotomy pain control; however, the overall quality of evidence was low.
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