Background: 

Perioperative opioids are problematic following craniotomy as they can impede neurological examination because of excessive sedation and mask surgical complications. Multimodal anesthetic techniques including nerve blocks have been used successfully to deliver opioid-free anesthesia in other surgical populations; however, no clinical data evaluating opioid-free anesthesia for craniotomy exists within the current body of literature.

Materials and Methods: 

Six prospectively identified patients underwent supratentorial craniotomy at Emory University Hospital using a multimodal opioid-free anesthetic (OFA) technique consisting of preoperative scalp block, dexmedetomidine and intravenous acetaminophen. These opioid-free patients were matched by age, sex, incision length, and incision location to 18 retrospectively identified control patients who underwent craniotomy using conventional, opioid-based anesthetic techniques. Postoperative opioid consumption and pain scores were compared and analyzed for noninferiority.

Results: 

Noninferiority of the OFA technique was demonstrated for opioid consumption at all measured intervals from postanesthesia care unit arrival to 24 hours postoperatively. Noninferiority was also demonstrated with respect to average postoperative pain scores from 0 to 12 hours, 0 to 24 hours, as well as length of postanesthesia care unit stay. Noninferiority was not shown for time to first rescue opioid postoperatively, pain scores for the 12 to 24 hours postoperative period, or time to emergence from anesthesia.

Conclusions: 

This pilot study demonstrates the feasibility of an OFA technique for patients undergoing supratentorial craniotomy and suggests that larger prospective randomized controlled trials are indicated to examine the role of multimodal anesthetic techniques for craniotomy.

中文翻译：

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开颅手术的无阿片类药物麻醉

背景： 

围手术期阿片类药物在开颅手术后存在问题，因为它们会因过度镇静和面罩手术并发症而阻碍神经系统检查。包括神经阻滞在内的多模式麻醉技术已成功用于其他手术人群的无阿片类药物麻醉；然而，目前的文献中没有评估开颅手术中无阿片类药物麻醉的临床数据。

材料和方法： 

六名前瞻性确定的患者在埃默里大学医院接受了幕上开颅手术，使用的是多模式无阿片类药物麻醉 (OFA) 技术，包括术前头皮阻滞、右美托咪定和静脉注射对乙酰氨基酚。这些无阿片类药物的患者按年龄、性别、切口长度和切口位置与 18 名回顾性确定的对照患者相匹配，这些对照患者使用传统的、基于阿片类药物的麻醉技术进行了开颅手术。比较术后阿片类药物消耗量和疼痛评分，并分析非劣效性。

结果： 

从麻醉后监护室到达到术后 24 小时的所有测量时间间隔，都证明了 OFA 技术在阿片类药物消耗方面的非劣效性。在 0 至 12 小时、0 至 24 小时的平均术后疼痛评分以及麻醉后监护室停留时间方面也证明了非劣效性。术后首次解救阿片类药物的时间、术后 12 至 24 小时的疼痛评分或从麻醉中苏醒的时间未显示非劣效性。

结论： 

这项初步研究证明了 OFA 技术对接受幕上开颅手术的患者的可行性，并建议进行更大规模的前瞻性随机对照试验来检查多模式麻醉技术在开颅手术中的作用。