PURPOSE Postoperative analgesia after corrective surgery of pediatric craniosynostosis is crucial in terms of short- and long-term outcomes. The objective of this observational study was to evaluate the effectiveness of an analgesic technique based on the scalp block versus traditional pharmacological approach. METHODS Thirteen patients, aged between 3 months and 2 years, undergoing surgical correction of craniosynostosis, received scalp nerve block before awakening (scalp block group). This group of patients was compared to a second group of 13 patients, retrieved from our database, treated with the traditional pharmacological approach (control group). Pain scores, need of rescue therapy, resumption of oral nutrition, degree of parent satisfaction at discharge, and length of stay in the Pediatric Intensive Care Unit (PICU) and in the hospital were compared between the two groups. RESULTS Objective Pain Score values were significantly lower in patients treated with scalp block at 30 min and at 8 h after extubation. The number of pharmacological interventions for the treatment of pain in PICU was significantly higher in Control group. Children in Scalp block group started earlier oral feeding than in Control group, both for clear fluids and milk. Length of stay in PICU was longer in Scalp block group than in Control group, though the difference between the mean data in the two groups is about 3 . This difference does not seem significant from a clinical standpoint, since it seems more related to logistic issues (e.g., availability of bed in the Pediatric Neurosurgery Unit, presence of a parent), rather than clinical problems contraindicating the discharge from PICU. Indeed, the overall hospital length of stay was similar between the two groups. CONCLUSION Scalp nerve block was effective for immediate postoperative pain control in patients younger than 2 years who underwent cranioplasty for craniosynostosis. The best pain control compared to conventional therapy allowed to limit the need for rescue analgesics in PICU and an earlier recovery time. ClinicalTrials.gov Identification: NCT04133467.

中文翻译：

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头颅阻滞用于颅骨纵缝手术术后疼痛控制的病例对照研究。

目的就小儿颅骨前突的矫正手术后的术后镇痛而言，短期和长期预后至关重要。这项观察性研究的目的是评估基于头皮阻滞与传统药理学方法的镇痛技术的有效性。方法13例年龄在3个月至2岁之间，正在接受颅内鼻窦吻合术的手术矫正的患者在苏醒前接受了头皮神经阻滞（头皮阻滞组）。将这组患者与第二组13名患者进行比较，这些患者是从我们的数据库中检索到的，采用传统药理学方法治疗（对照组）。疼痛评分，需要急救治疗，恢复口腔营养，出院时父母的满意程度，比较两组的儿科重症监护病房（PICU）和住院时间。结果拔管后30分钟和8 h，头皮阻滞治疗的患者的客观疼痛评分值明显较低。对照组PICU治疗疼痛的药理干预次数明显增多。头皮阻滞组的孩子开始进食比对照组的早，无论是清液还是牛奶。尽管两组的平均数据之间的差异约为3，但头皮阻滞组中PICU的住院时间长于对照组。从临床的角度来看，这种差异似乎并不明显，因为它似乎与后勤问题（例如，儿科神经外科病床的可利用性，父母的存在）有更多关系，而不是禁止从PICU排出的临床问题。确实，两组的总住院时间相似。结论头颅神经阻滞可有效治疗2岁以下因颅骨融合症而行颅骨成形术的患者，术后即刻控制疼痛。与传统疗法相比，最佳的疼痛控制可以限制PICU中急救镇痛药的使用，并缩短恢复时间。ClinicalTrials.gov标识：NCT04133467。与传统疗法相比，最佳的疼痛控制可以限制PICU中急救镇痛药的使用，并缩短恢复时间。ClinicalTrials.gov标识：NCT04133467。与传统疗法相比，最佳的疼痛控制可以限制PICU中急救镇痛药的使用，并缩短恢复时间。ClinicalTrials.gov标识：NCT04133467。