Indian Journal of Anaesthesia  
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Year : 2019  |  Volume : 63  |  Issue : 11  |  Page : 886-894

Scalp block for analgesia after craniotomy: A meta-analysis

Department of Anesthesiology and Intensive Therapy, Faculty of Medical, Public Health and Nursing, University of Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia

Correspondence Address:
Dr. Ardyan Wardhana
Department of Anesthesiology and Intensive Therapy, Kesehatan Street, Yogyakarta
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_315_19

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Background and Aims: A previous meta-analysis reported that scalp block had limited benefits (low-quality evidence) compared to no-scalp block modalities for analgesia after craniotomy. However, it included studies using two different pain intensity measurement scales. Therefore, we performed another meta-analysis using a single scale. Methods: We conducted the search for all randomised controlled trials evaluating the effect of scalp block on postcraniotomy pain compared to no-scalp block in Cochrane Central Register of Controlled Trials and PubMed database. We assessed the quality of included studies employing GRADE approach. We performed random-effects inverse-variance weighted meta-analysis of outcomes including pain intensity assessed by a 0--10 visual analog scale and opioid consumption during the first 24 h postoperative period using RevMan 5.3. Results: A total of 10 studies (551 patients) were included. It revealed a statistically significant mean pain intensity reduction in scalp block group when compared to no-scalp block at very early and early 24 h period (seven trials, very low-quality evidence, mean difference (MD) = −1.37, 95% confidence interval (CI): −2.23 to -0.05, I2 = 70%; nine trials, very low-quality evidence, MD = −1.16, 95% CI: −2.09 to −0.24, I2 = 57%, respectively). There was also reduction in the opioid requirements over the first 24 h postoperatively. Conclusion: Scalp block might be useful at <6 h postcraniotomy with very-low quality evidence. Additionally, it had uncertain but moderate effect on reducing total 24 h opioid consumption. Therefore, more studies are needed to reach optimal information size.

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