Parecoxib as an Adjuvant to Scalp Nerve Blocks for Relief of Post-craniotomy Pain
Status:
Recruiting
Trial end date:
2021-12-31
Target enrollment:
Participant gender:
Summary
Pain is common for the first 2 days after major craniotomy. Inadequate analgesia induced
sympathetically mediated hypertension may lead to an increased risk for post-operative
complications, such as arterial hypertension, intracranial hemorrhage, prolonged hospital
stay, and mortality.Pain after craniotomy derives from the scalp and pericranial
muscles.Scalp block with local anesthesia seems to provide effective and safe anesthetic
management.Scalp block can be performed by directly blocking the six different nerves that
provide the sensory innervation of the scalp in neurological surgery.Even if adrenaline as an
additive agent, scalp block using 0.5% or 0.75% bupivacaine with adrenaline could only
improve postoperative analgesic for up to six hours after craniotomy.However, pain is common
for the first 2 days after major elective intracranial surgery, and the relatively short
analgesic time of scalp nerve blocks does not seem to meet the requirements of craniotomy.
Therefore, how to improve the quality and duration of scalp nerve blocks with local
anesthetics is of great significance.Parecoxib is a NSAIDs that specifically inhibits the
enzyme COX-2.Liu et al firstly applied parecoxib as an adjuvant to local anesthetics on
peripheral nerve blocks and reported 20 mg parecoxib added to ropivacaine injected locally on
the brachial plexus nerve prolonged the motor and sensory block times of the nerve blockade
and ameliorated postoperative pain intensity for patients receiving forearm orthopaedic
surgery. However, there has not been reported about local application of parecoxib on scalp
nerve blocks. The investigators postulate that parecoxib may be also ideal for scalp nerve
blocks for relief of post-craniotomy pain, and further research is needed.
The APONIA trial aims to establish whether scalp blocks with a mixture of ropivacaine plus
parecoxib is able to relieve patients' postoperative pain compared with local anesthetics
alone, thereby potentially changing medical practice.