RESUMO
There is no consensus on the management of post-craniotomy pain. Several randomized controlled trials have examined the use of a regional scalp block for post-craniotomy pain. We aim to investigate whether scalp block affected short or long-term pain levels and opioid use after craniotomy. This study prospectively administered selective scalp blocks (lesser occipital, preauricular nerve blockâ¯+â¯pin site block) in 20 consecutive patients undergoing craniotomy for semicircular canal dehiscence. Anesthesia, pain, and opioid outcomes in these patients were compared to 40 consecutive historic controls. There was no significant difference in patient demographics between the two groups and no complications related to selective scalp block. The time between the end of procedure and end of anesthesia decreased in the scalp block group (16 vs 21â¯min, Pâ¯=â¯0.047). Pain scores were significantly less in the scalp block group for the first 4â¯h, after which there was no statistically significant difference. Time to opioid rescue was longer in the scalp block group (3.6 vs 1.8â¯h, HR 0.487, Pâ¯=â¯0.0361) and opioid use in the first 7â¯h was significantly less in the scalp block group. Total opioid use, outpatient opioid use, and length of stay did not differ. Selective scalp block is a safe and effective tool for short-term management of postoperative pain after craniotomy and decreases the medication requirement during emergence and recovery. Selective scalp block can speed up OR turnover but is not efficacious in the treatment of postoperative pain beyond this point.
Assuntos
Analgésicos Opioides , Bloqueio Nervoso , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Craniotomia , Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Couro CabeludoRESUMO
Previous studies have looked at differences in predisposing factors, symptomology, treatment options, and outcomes in patients with SSCD experiencing audiologic and vestibular symptoms, however this study utilizes data from the largest series of SSCD patients by a single pair of neurosurgeon and head and neck surgeon to date. The objective was to determine what pre-operative factors, if any, contribute to post-operative outcomes in SSCD patients. A retrospective chart review collected patient demographics, preoperative symptoms, and postoperative symptoms. Nonparametric tests were run using IBM® SPSS® Statistics. Fisher's Exact Tests, Spearman's rho, and McNemar's test for paired comparison of binary measures were performed, with a significance level of Pâ¯<â¯0.05. A total of 156 SSCD surgeries were performed within a cohort of 119 patients. The majority of patients were female (nâ¯=â¯75, 63.0%). The median age was 55â¯years (±12.7â¯years) and median follow-up length was 0.46â¯months (range: 0.03-59.5â¯months). Increased postoperative dizziness and hearing loss was significantly correlated with females (Pâ¯=â¯.048, Pâ¯=â¯.041). Additionally, males reported significantly improved postoperative hearing (Pâ¯=â¯.044) with confirmatory audiometry. Serum ionized calcium levels inversely correlated with age using spearman's coefficient (rsâ¯=â¯-.260 Pâ¯=â¯.037). Postsurgical autophony was significantly associated with bilateral SSCD (Pâ¯=â¯.01). In conclusion, differences in outcomes between patients may have to do with bilateralism of SSCD or gender effects. Proposed theories concerning a "two hit" hypothesis and about calcium feedback regulation in SSCD may play a role in these findings. Understanding differences between symptomology will help facilitate discussions with future patients.