• J Neurosurg Anesthesiol · Apr 2024

    Randomized Controlled Trial

    Ultrasound-guided Greater Occipital Nerve Block in Children Undergoing Posterior Fossa Craniotomy: A Randomized, Controlled Trial.

    • Heba Nassar, Khaled Sarhan, Maha Gamil, Manal Elgohary, Hany El-Hadi, and Sahar Mahmoud.
    • Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
    • J Neurosurg Anesthesiol. 2024 Apr 1; 36 (2): 159163159-163.

    BackgroundPosterior fossa surgery is commonly associated with severe postoperative pain. This study assessed the impact of ultrasound-guided greater occipital nerve (GON) block on postoperative pain and hemodynamic profiles in pediatric posterior fossa craniotomy.Materials And MethodsChildren aged 2 to 12 years undergoing elective posterior fossa craniotomy with general anesthesia were randomly allocated to a control group receiving standard care (n=18) or a GON block group receiving standard care plus bilateral ultrasound-guided GON block (=17). Outcomes were postoperative pain assessed using the objective pain scale, time to first postoperative analgesia, intraoperative fentanyl consumption, perioperative blood pressure and heart rate, incidence of nausea and vomiting, and nerve-block-related complications.ResultsObjective pain scale scores were lower in the GON block group than in the control group at 2, 4, 6, 8 (all P =0.0001), 12 ( P =0.001), 16 ( P =0.03), and 24-hour ( P =0.004) postoperatively. The time to first analgesic request was 13.4±7.4 hours in the GON block group and 1.8±1.5 hours in the control group ( P <0.001). Intraoperative fentanyl consumption was 2.68±0.53 μg/kg -1 in the GON block group and 4.1±0.53 μg/kg -1 in the control group ( P =0.0001). Systolic blood pressure was lower in the GON block group at several intraoperative and postoperative time points, whereas heart rate was similar in the two groups at most time points. The incidence of postoperative nausea and vomiting was similar between groups ( P =0.38), and there were no nerve-block-related complications.ConclusionsIn children undergoing posterior fossa craniotomy, GON block was associated with superior quality and duration of postoperative analgesia and better hemodynamic profile compared with standard care.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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