Ropivacaine instillation through subgaleal drain: A novel approach for acute post-craniotomy pain.

Publisher: Medknow Country of Publication: India NLM ID: 0013243 Publication Model: Print-Electronic Cited Medium: Print ISSN: 0019-5049 (Print) Linking ISSN: 00195049 NLM ISO Abbreviation: Indian J Anaesth Subsets: PubMed not MEDLINE

Publication: Mumbai : Medknow
Original Publication: Varanasi : A. Lal on behalf of The Indian Society Of Anaesthetists

Background and Aims: Post-craniotomy pain has often been overlooked and undertreated. Various classes of analgesic drugs have been used, not without limitations. Therefore, we planned to study the novel technique of wound instillation of ropivacaine through the surgical drain in patients undergoing supratentorial craniotomy to study its effect on post-craniotomy pain, analgesic requirement in the post-operative period along with the recovery profile of the patient and the side effects.
Methods: This prospective, randomised, placebo-controlled, double-blinded study enroled 50 patients of either gender, scheduled to undergo elective craniotomy, under general anaesthesia. They were randomly divided into two groups and received either 12 ml of 0.25% ropivacaine (group R) or 12 ml of normal saline (group NS), through the subgaleal drain, after the closure of the dura. Pain scores were assessed at 1, 2, 4, 8 and 24 hours post-operatively. Student's t-test was used for comparison of continuous variables and the Chi-square test or Fisher's exact test was used for comparing the nominal categorical data.
Results: The visual analogue scale score was higher in group NS than in group R, and the difference was statistically significant ( P = 0.012, 0.016, and 0.005 at 0, 1, and 2 post-operative hours, respectively). The difference in the mean emergence time in the two groups was 1.12 minutes ( P = 0.024).
Conclusion: Single-time wound instillation of ropivacaine (12 ml of 0.25%) through surgical (subgaleal) drain during wound closure is an effective and simple technique for reducing post-operative pain and analgesic consumption and early emergence in neurosurgical patients undergoing supratentorial craniotomy.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2022 Indian Journal of Anaesthesia.)

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Keywords: Craniotomy; drug instillation; pain; ropivacaine

Date Created: 20220916 Latest Revision: 20220917

20221213

PMC9468998

10.4103/ija.ija_646_21

36111089