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Pre-emptive scalp infiltration with dexamethasone plus ropivacaine for postoperative pain after craniotomy: a protocol for a prospective, randomized controlled trial

Authors Jia Y, Zhao C, Ren H, Wang T, Luo F

Received 12 October 2018

Accepted for publication 18 March 2019

Published 24 May 2019 Volume 2019:12 Pages 1709—1719

DOI https://doi.org/10.2147/JPR.S190679

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Erica Wegrzyn


Yitong Jia,1,* Chunmei Zhao,1,* Hao Ren,1,* Tao Wang,2,* Fang Luo3

1Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University; 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; 3Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China

*These authors contributed equally to this work

Background: Approximately 55–87% of the patients undergoing craniotomy experience moderate to severe pain during the first 48 hrs after surgery, which negatively influences patients’ postoperative rehabilitation. Recently, local infiltration of analgesia (LIA) has been widely performed clinically as a promising analgesic method that could avoid the side effects of analgesics but only has a short pain-free duration; researchers have clarified that the addition of dexamethasone to LIA could provide significant analgesic effects and significantly prolong the duration of analgesic effects without obvious complications for various types of surgeries. To date, no studies have evaluated the addition of dexamethasone to LIA for patients receiving craniotomy. The aim of the study was to test the hypothesis that pre-emptive scalp infiltration with a steroid (dexamethasone) plus a local anesthetic (ropivacaine) could achieve superior postoperative analgesic effects to a local anesthetic (ropivacaine) alone in adult patients undergoing a craniotomy.
Study design and methods: This study is a randomized controlled trial that will include one intervention and one control group involving a total of 140 adults scheduled for elective craniotomy for resection of supratentorial tumors under general anesthesia and with an anticipated full recovery within 2 hrs postoperatively. The intervention will involve pre-emptive scalp infiltration with ropivacaine plus dexamethasone (the dexamethasone group) or ropivacaine alone (the control group), and the participants in both groups will complete a 6-month follow-up. The primary outcome will be the cumulative sufentanil consumption within 48 hrs postoperatively.
Discussion: The intervention, if effective, this study will provide clinically important information on the role of dexamethasone in scalp infiltration for post-craniotomy pain management.

Keywords: postoperative pain, craniotomy, pre-emptive scalp infiltration, dexamethasone, sufentanil consumption

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