Ultrasound-guided superficial cervical plexus blocks for persistent pain after suboccipital craniotomies: a randomized trial.

IF 9.1 1区 医学 Q1 ANESTHESIOLOGY Anesthesiology Pub Date : 2024-09-23 DOI:10.1097/ALN.0000000000005238
Min Zeng, Maoyao Zheng, Yue Ren, Xueke Yin, Shu Li, Yan Zhao, Dexiang Wang, Liyong Zhang, Xiudong Guan, Deling Li, Daniel I Sessler, Yuming Peng
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Abstract

Background: The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. We therefore tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies.

Methods: We conducted a single-center randomized and blinded parallel-group trial. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml of 0.5% ropivacaine or a comparable amount of normal saline. Injections were into the superficial layer of prevertebral fascia. The primary outcome was the incidence of persistent pain three months after surgery.

Results: From Nov 2021 to August 2023, 292 qualifying patients were randomly allocated to blocks with ropivacaine (n=146) or saline (n=146). The average ± SD age of participating patients was 45±12 years and the duration of surgery was 4.2±1.3 hours. Persistent pain 3 months after surgery was reported by 48 (34%) of patients randomized to ropivacaine versus 73 (51%) in those assigned to saline (relative risk 0.66; 95% CI, 0.50 to 0.88; P = 0.003) in the per-protocol population, and by 53 (36%) of patients randomized to ropivacaine versus 77 (53%) in those assigned to saline (relative risk 0.69, 95% CI, 0.53 to 0.90; P = 0.005) in the intention-to-treat population.

Conclusion: Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.

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超声引导下浅颈丛阻滞治疗枕下开颅术后持续疼痛:随机试验。
背景:浅层颈丛神经阻滞对减轻开颅术后持续疼痛的疗效仍不明确。因此,我们测试了一个主要假设,即术前超声引导下的颈浅神经丛阻滞能减轻枕骨下开颅手术后 3 个月的持续性疼痛:我们进行了一项单中心随机盲法平行组试验。符合条件的枕骨下开颅手术患者被随机分配到使用 10 毫升 0.5% 罗哌卡因或等量生理盐水的浅层颈丛阻滞治疗中。注射部位为椎前筋膜浅层。主要结果是术后三个月持续疼痛的发生率:从2021年11月到2023年8月,292名符合条件的患者被随机分配到使用罗哌卡因(146人)或生理盐水(146人)的阻滞治疗中。参与患者的平均(± SD)年龄为 45±12 岁,手术时间为 4.2±1.3 小时。随机接受罗哌卡因治疗的患者中有 48 人(34%)在术后 3 个月出现持续疼痛,而接受生理盐水治疗的患者中有 73 人(51%)在术后 3 个月出现持续疼痛(相对风险为 0.66;95% CI 为 0.50 至 0.88;P = 0.003),在意向治疗人群中,随机接受罗哌卡因治疗的患者为53人(36%),而接受生理盐水治疗的患者为77人(53%)(相对风险为0.69,95% CI为0.53至0.90;P = 0.005):结论:颈浅神经丛阻滞可将枕骨下开颅术后恢复期患者切口持续疼痛的发生率降低约三分之一。
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来源期刊
Anesthesiology
Anesthesiology 医学-麻醉学
CiteScore
10.40
自引率
5.70%
发文量
542
审稿时长
3-6 weeks
期刊介绍: With its establishment in 1940, Anesthesiology has emerged as a prominent leader in the field of anesthesiology, encompassing perioperative, critical care, and pain medicine. As the esteemed journal of the American Society of Anesthesiologists, Anesthesiology operates independently with full editorial freedom. Its distinguished Editorial Board, comprising renowned professionals from across the globe, drives the advancement of the specialty by presenting innovative research through immediate open access to select articles and granting free access to all published articles after a six-month period. Furthermore, Anesthesiology actively promotes groundbreaking studies through an influential press release program. The journal's unwavering commitment lies in the dissemination of exemplary work that enhances clinical practice and revolutionizes the practice of medicine within our discipline.
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