Effect of scalp infiltration with bupivacaine on analgesic requirement following elective craniotomy.

Background: Postcraniotomy pain and perioperative assessment of patients' neurological function are some of the issues associated with craniotomy surgeries. Cost-effective pain control will result in good clinical outcome, decrease the length of hospital stay, and reduce total cost. Infiltration anesthesia is a recognized modality of cost-effective pain control. Objective: The study determined the effect of scalp infiltration with 0.25% plain bupivacaine on pain control following craniotomy. Methods: A prospective randomized study recruited 50 consenting patients scheduled for craniotomy under general anesthesia into two study groups. All patients received routine general anesthesia as per local protocol and received scalp infiltration after skin closure. Group A received 20 ml of 0.25% plain bupivacaine, while Group B received 20 ml normal saline. Pain scores were assessed using the Visual Analog Scale (VAS) on admission into the intensive care unit (ICU) then at 4, 8, 12, 16, 20, 24, and 48 h after surgery. The interval between the end of surgery and the first request for analgesia, 4 hourly intervals pentazocine and the cumulative doses of pentazocine given for postoperative pain relief. Results: The presenting VAS at the ICU and total postoperative analgesic consumption at 48 h were significantly lower in the bupivacaine group compared to the saline group. In addition, the increase in time to the first analgesic request was statistically significant between the two. There was a trend toward the reduced incidence of sedation and postoperative nausea and vomiting in the bupivacaine group compared to the saline group. Conclusions: Postoperative scalp infiltration with plain 0.25% bupivacaine reduced pain intensity and opioid analgesic consumption among the studied patients. Resultantly, it can be regarded as an effective technique of pain management after an elective craniotomy.

Résumé Contexte: La douleur post-craniotomie et l'évaluation périopératoire de la fonction neurologique des patients sont quelques-uns des problèmes associés aux chirurgies de craniotomie. Un contrôle de la douleur rentable se traduira par de bons résultats cliniques, réduira la durée du séjour à l'hôpital et réduira le coût total. L'anesthésie par infiltration est une modalité reconnue de contrôle de la douleur rentable. Objectif: L'étude a déterminé l'effet de l'infiltration du cuir chevelu avec de la bupivacaïne simple à 0,25 % sur le contrôle de la douleur après une craniotomie. Méthodes: Une étude prospective randomisée a recruté 50 patients consentants devant subir une craniotomie sous anesthésie générale en deux groupes d'étude. Tous les patients ont reçu une anesthésie générale de routine selon le protocole local et ont reçu une infiltration du cuir chevelu après la fermeture de la peau. Le groupe A a reçu 20 ml de bupivacaïne simple à 0,25%, tandis que le groupe B a reçu 20 ml de solution saline normale. Les scores de douleur ont été évalués à l'aide de l'échelle visuelle analogique (EVA) à l'admission en unité de soins intensifs (USI) puis à 4, 8, 12, 16, 20, 24 et 48 h après la chirurgie. L'intervalle entre la fin de la chirurgie et la première demande d'analgésie, les intervalles de quatre heures de Pentazocine ainsi que les doses cumulées de Pentazocine administrées pour le soulagement de la douleur postopératoire ont été enregistrés. Résultats: L'EVA présentée à l'USI et la consommation totale d'analgésique postopératoire à 48 h étaient significativement plus faibles dans le groupe bupivacaïne par rapport au groupe solution saline. De plus, l'augmentation du délai jusqu'à la première demande d'analgésique était statistiquement significative entre les deux. Il y avait une tendance à la réduction de l'incidence de la sédation et des nausées et vomissements postopératoires dans le groupe bupivacaïne par rapport au groupe solution saline. Conclusions: L'infiltration postopératoire du cuir chevelu avec de la bupivacaïne simple à 0,25 % a réduit l'intensité de la douleur et la consommation d'analgésiques opioïdes chez les patients étudiés. Par conséquent, elle peut être considérée comme une technique efficace de gestion de la douleur après une craniotomie élective. Mots-clés: Analgésie, bupivacaïne, craniotomie, infiltration du cuir chevelu.

Nigerian surgical outcomes - Report of a 7-day prospective cohort study and external validation of the African surgical outcomes study surgical risk calculator.

BACKGROUND: Surgical outcomes study for individual nations remains important because of international differences in patterns of surgical disease. We aimed to contribute to data on post-operative complications, critical care admissions and mortality following elective surgery in Nigeria and also validate the African Surgical Outcomes Study (ASOS) surgical risk calculator in our adult patient cohort. MATERIALS AND METHODS: We conducted a 7-day, national prospective observational cohort study in consented consecutive patients undergoing elective surgery with a planned overnight hospital stay following elective surgery during a seven-day study period. The outcome measures were in-hospital postoperative complications, critical care admissions and in-hospital mortality censored at 30 days. Also, we identified variables which significantly contributed to higher ASOS surgical risk score. External validation was performed using area under the receiver operating characteristic curve (ROC) for discrimination assessment and Hosmer-Lemeshow test for calibration. RESULTS: A total of 1,425 patients from 79 hospitals participated in the study. Postoperative complications occurred in 264(18.5%, 95% CI 16.6-20.6), 20(7.6%) of whom were admitted into the ICU and 16(6.0%) did not survive. Total ICU admission was 57 (4%), with mortality rate of 23.5% following planned admission and overall in-hospital death was 22(1.5%, 95% CI 0.9-2.2). All prognostic factors in the ASOS risk calculator were significantly associated with higher ASOS score and the scoring system showed moderate discrimination (0⋅73, 95% CI 0.62-0.83). Hosmer-Lemeshow χ2 test revealed scale was well calibrated in the validation cohort. CONCLUSION: NiSOS validates the findings of ASOS and the ability of the ASOS surgical risk calculator to predict risk of developing severe postoperative complications and mortality. We identified failure-to-rescue as a problem in Nigeria. Furthermore, this study has provided policy makers with benchmarks that can be used to monitor programmes aimed at reducing the morbidity and mortality after elective surgery. We recommend the adoption of the ASOS surgical risk calculator as a tool for risk stratification preoperatively for elective surgery.