Pain after supratentorial craniotomy is common, 55 % to 80 % of patients experience moderate to severe pain in the first 48 h(1-7). The importance of intravenous dexamethasone as an adjuvant to local anaesthetics is increasingly applied(1-7), however its role in scalp nerve blocks with ropivacaine 0.75 % remains unexplored in post-operative analgesia. We analyzed 134 supratentorial craniotomies under general anaesthesia, 46 of which had preoperatively bilateral scalp nerve blocks with ropivacaine 0.75 %. The general anaesthesia was standardized and included 8 mg of intravenous dexamethasone at the induction. The postoperative pain was assessed using the numerical rating scale with patients in the post anaesthesia care unit and subsequently every 8 h in the neurosurgery unit until the 48th hour. A NRS value above 3 led to the administration of a rescue analgesic according to the defined protocol until an efficient analgesia was obtained. Postoperative pain was controlled in both groups, however the need for rescue analgesics in the scalp nerve blocks group was reduced by 40 % (39 % vs. 65 %; p = 0.006) compared to the control group. More than 60 % of the patients from the scalp nerve blocks group had an efficient analgesia without any rescue analgesic. Peroperatively the scalp nerve blocks group showed a decrease in opioid consumption and a better hemodynamic stability. No anesthetic or chirurgical complications related to the use of scalp blocks were observed. Scalp nerve blocks associated with intravenous dexamethasone are found to be a straightforward and efficient analgesic approach during supratentorial craniotomies.

中文翻译：

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使用 0.75% 罗哌卡因与静脉注射地塞米松相关的头皮神经阻滞用于缓解开颅术后疼痛的疗效

幕上开颅手术后的疼痛很常见，55% 到 80% 的患者在前 48 小时内出现中度至重度疼痛 (1-7)。静脉注射地塞米松作为局部麻醉剂的辅助剂的重要性得到越来越多的应用 (1-7)，但其在用 0.75% 罗哌卡因进行头皮神经阻滞中的作用在术后镇痛中的作用仍未得到探索。我们分析了 134 例在全身麻醉下进行的幕上开颅手术，其中 46 例在术前使用了 0.75% 的罗哌卡因进行了双侧头皮神经阻滞。全身麻醉是标准化的，包括在诱导时静脉注射地塞米松 8 毫克。术后疼痛在麻醉后监护病房中使用数字评分量表评估，随后每 8 小时在神经外科病房评估一次，直到第 48 小时。高于 3 的 NRS 值导致根据定义的协议施用救援镇痛剂，直到获得有效镇痛。两组的术后疼痛均得到控制，但与对照组相比，头皮神经阻滞组对抢救性镇痛药的需求减少了 40%（39% 对 65%；p = 0.006）。头皮神经阻滞组超过 60% 的患者获得了有效的镇痛效果，无需任何救援镇痛剂。术中头皮神经阻滞组阿片类药物消耗量减少，血流动力学稳定性更好。没有观察到与使用头皮块相关的麻醉或手术并发症。发现与静脉注射地塞米松相关的头皮神经阻滞是幕上开颅手术中一种直接而有效的镇痛方法。