Effect of Scalp Infiltration with Bupivacaine on Analgesic Requirement Following Elective Craniotomy

BACKGROUND: Postcraniotomy pain and perioperative assessment of patients' neurological function are some of the issues associated with craniotomy surgeries. Cost-effective pain control will result in good clinical outcome, decrease the length of hospital stay, and reduce total cost. Infiltration anesthesia is a recognized modality of cost-effective pain control. OBJECTIVE: The study determined the effect of scalp infiltration with 0.25% plain bupivacaine on pain control following craniotomy. METHODS: A prospective randomized study recruited 50 consenting patients scheduled for craniotomy under general anesthesia into two study groups. All patients received routine general anesthesia as per local protocol and received scalp infiltration after skin closure. Group A received 20 ml of 0.25% plain bupivacaine, while Group B received 20 ml normal saline. Pain scores were assessed using the Visual Analog Scale (VAS) on admission into the intensive care unit (ICU) then at 4, 8, 12, 16, 20, 24, and 48 h after surgery. The interval between the end of surgery and the first request for analgesia, 4 hourly intervals pentazocine and the cumulative doses of pentazocine given for postoperative pain relief. RESULTS: The presenting VAS at the ICU and total postoperative analgesic consumption at 48 h were significantly lower in the bupivacaine group compared to the saline group. In addition, the increase in time to the first analgesic request was statistically significant between the two. There was a trend toward the reduced incidence of sedation and postoperative nausea and vomiting in the bupivacaine group compared to the saline group. CONCLUSIONS: Postoperative scalp infiltration with plain 0.25% bupivacaine reduced pain intensity and opioid analgesic consumption among the studied patients. Resultantly, it can be regarded as an effective technique of pain management after an elective craniotomy.