Effect of scalp nerve block on postcraniotomy analgesia in children: a randomized, controlled trial.

Objective: Effective postoperative pain management is critical for pediatric craniotomies. Scalp nerve block (SNB) interventions present a potential solution, yet their comparative benefits in preoperative and postoperative settings remain unclear. This study investigated the analgesic effects of SNB in pediatric craniotomy patients by comparing preoperative versus postoperative administration.

Methods: This randomized trial included 180 children (1-12 years) who underwent elective craniotomy and were assigned to the preoperative, postoperative, or nonblocking control group. The outcomes included cumulative sufentanil use, pain scores (1, 2, 4, 24, 48 h postoperation), rescue medicine utilization, postoperative complications (24, 48 h), and hospitalization length. The primary outcome was total sufentanil use within 24 h postsurgery.

Results: Total sufentanil use (µg·kg) in the postoperative block group was significantly lower than that in the nonblocking control group at 1 h (P < 0.001, 95% CI [-0.024 to -0.006]), 2 h (P < 0.001, 95% CI [-0.054 to -0.020]), 4 h (P < 0.001, 95% CI [-0.089 to -0.032]), 24 h (P < 0.001, 95% CI [-0.192 to -0.047]), and 48 h (P = 0.010, 95% CI [-0.208 to -0.022]) postoperation. Additionally, sufentanil use in the preoperative block group was significantly lower than that in the nonblocking control group at 1 h (P = 0.004, 95% CI [-0.021 to -0.003]), 2 h (P < 0.001, 95% CI [-0.043 to -0.010]), and 4 h (P = 0.002, 95% CI [-0.069 to -0.013]). Within 24 h postoperation, the use of sufentanil in the postoperative block group was significantly lower than that in the preoperative block group (P = 0.014, 95% CI [-0.157 to -0.013]).

Conclusion: Compared with preoperative SNB or nonblocking, postoperative SNB significantly reduces postoperative sufentanil use within 24 h for pediatric patients undergoing craniotomy, highlighting its potential as an effective analgesic intervention in this population.

Trial Registration: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR1800017386) on 27/07/2018, under the title "A study of scalp nerve block for neurosurgical analgesia in children with craniotomy."