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Ultrasound-guided Superficial Cervical Plexus Blocks for Persistent Pain after Suboccipital Craniotomies

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Authors: Zeng, Min M.D., Ph.D. et al

Anesthesiology 142(1):p 166-175, January 2025.

Background:

The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. The authors tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies.

Methods:

A single-center randomized and blinded parallel-group trial was conducted. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml 0.5% ropivacaine or a comparable amount of normal saline. Injections were into the superficial layer of prevertebral fascia. The primary outcome was the incidence of persistent pain three months after surgery.

Results:

From November 2021 to August 2023, a total of 292 qualifying patients were randomly allocated to blocks with ropivacaine (n = 146) or saline (n = 146). The average ± SD age of participating patients was 45 ± 12 yr, and the duration of surgery was 4.2 ± 1.3 h. Persistent pain 3 months after surgery was reported by 48 (34%) of patients randomized to ropivacaine versus 73 (51%) in those assigned to saline (relative risk, 0.66; 95% CI, 0.50 to 0.88; P = 0.003) in the per-protocol population, and by 53 (36%) of patients randomized to ropivacaine versus 77 (53%) in those assigned to saline (relative risk, 0.69; 95% CI, 0.53 to 0.90; P = 0.005) in the intention-to-treat population.

Conclusions:

Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.

Abstract

What We Already Know about This Topic

Regional anesthesia reduces chronic postsurgical pain after various surgical procedures

What This Article Tells Us That Is New

This randomized, blinded, placebo-controlled trial assessed superficial cervical plexus block for prevention of persistent incisional pain in 292 patients having suboccipital craniotomies

In patients assigned to superficial cervical plexus block with 0.5% ropivacaine, the incidence of incisional pain 3 months after surgery was 36% versus 53% in those randomized to saline (relative risk, 0.69; 95% CI, 0.53 to 0.90; P = 0.005)

Mild incisional pain (1 to 3) at 3 months was reported by 29% of the ropivacaine group versus 42% of the saline group, and moderate to severe pain (4 to 10) was reported by 5% of the ropivacaine group versus 9% of the saline group

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