When to Block? Timing of Scalp Block in Craniotomy

NCT ID: NCT07043621

Last Updated: 2025-06-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-06-30

Study Completion Date

2025-12-31

Brief Summary

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This study aims to evaluate the effect of scalp block timing-whether administered preoperatively or postoperatively-on postoperative recovery quality in patients undergoing craniotomy. The recovery quality will be assessed using the validated Quality of Recovery-40 (QoR-40) questionnaire. A total of 60 patients, aged 18-80 years, classified as ASA I-III and with a Glasgow Coma Scale (GCS) score of 15 upon admission to the recovery unit, will be enrolled. The primary outcome is the QoR-40 score. Secondary outcomes include hemodynamic changes and pain intensity measured by the Visual Analog Scale (VAS).

Detailed Description

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Craniotomy is a surgical procedure involving the opening of the skull to access the brain. Awakening patients after craniotomy must be performed gradually to maintain hemodynamic stability. During the procedure, injury to soft tissues and muscles can lead to somatic pain, which may cause hypertension and tachycardia, potentially increasing intracranial pressure and resulting in cerebral edema or hematoma. Therefore, effective postoperative pain management and hemodynamic stability are crucial in neurosurgical patients.

Post-craniotomy pain control methods include opioids, non-steroidal anti-inflammatory drugs (NSAIDs), local anesthetic infiltration at the incision site, and scalp block. However, prolonged opioid use is not recommended due to the risk of dependence and negative cognitive effects. Scalp block has been shown to be effective in controlling post-craniotomy pain and offers prolonged analgesia.

The Quality of Recovery-40 (QoR-40) questionnaire, developed by P.S. Myles, is a validated tool used to assess postoperative recovery. It is a five-point Likert-type scale consisting of 40 items, divided into five subscales: emotional state (9 items), physical comfort (12 items), psychological support (7 items), physical independence (5 items), and pain (7 items). Total scores range from 40 to 200, with higher scores indicating better recovery.

While the efficacy of scalp block in post-craniotomy pain control is well established, limited data exist regarding the influence of timing of block administration on recovery quality. This study aims to compare the effects of preoperative versus postoperative scalp block on recovery, using the QoR-40 questionnaire.

A total of 60 patients undergoing craniotomy at Sakarya University Training and Research Hospital will be included. Eligibility criteria include patients aged 18-80 years, classified as ASA I-III, and with a postoperative GCS of 15. Exclusion criteria include chronic preoperative use of analgesics, GCS \<15, known allergy to local anesthetics or opioids used in scalp block or patient-controlled analgesia.

The primary outcome is the QoR-40 score. Secondary outcomes include intraoperative and postoperative hemodynamic parameters and postoperative pain scores measured with the Visual Analog Scale (VAS).

Conditions

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Scalp Block Regional Anesthesia Craniotomy Surgery QoR-40

Keywords

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Scalp Block Craniotomy surgery analgesia postoperative pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

A total of 60 patients undergoing elective craniotomy will be randomly assigned to one of two parallel groups (n=30 per group). Group 1 will receive a preoperative scalp block, while Group 2 will receive a postoperative scalp block. A blinded investigator will monitor intraoperative hemodynamic parameters and assess both intraoperative and postoperative opioid and analgesic consumption. Postoperatively, all patients will complete the validated Quality of Recovery-40 (QoR-40) questionnaire to evaluate recovery outcomes. The study aims to compare the effect of scalp block timing on postoperative recovery and analgesic requirements.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

DOUBLE

Participants Outcome Assessors
A blinded investigator will monitor intraoperative hemodynamics, evaluate opioid/analgesic use, and assess postoperative recovery using the QoR-40 questionnaire.

Study Groups

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Early Scalp Block Group

Patients in this group will receive a scalp block with 0.25% bupivacaine (20 mL) administered under ultrasound guidance after the induction of general anesthesia but prior to head pinning

Group Type ACTIVE_COMPARATOR

Early Scalp Block Group

Intervention Type PROCEDURE

Following induction of general anesthesia and prior to head pinning (Mayfield clamp placement), a scalp block was performed under aseptic conditions using 20 mL of 0.25% bupivacaine.

The block targeted six sensory nerves that innervate the scalp: Supraorbital nerve, Supratrochlear nerve, Auriculotemporal nerve ,Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve.

Each nerve was infiltrated subcutaneously at its anatomical location using a 25-gauge needle, with the total volume distributed evenly or proportionally across the injection sites.

Postoperative Scalp Block Group

Patients in this group will receive a scalp block with 0.25% bupivacaine (20 mL) administered under ultrasound guidance at the end of surgery, before emergence from anesthesia.

Group Type ACTIVE_COMPARATOR

Late Scalp Block Group

Intervention Type PROCEDURE

In the pre-emergence group, the scalp block was performed at the end of surgery but before emergence from general anesthesia, while the patient was still under deep anesthesia.

Under strict aseptic conditions, 20 mL of 0.25% bupivacaine was administered to block the following six sensory nerves innervating the scalp: Supraorbital nerve, Supratrochlear nerve, Auriculotemporal nerve, Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve.

The local anesthetic was injected subcutaneously at the anatomical landmarks of each nerve using a 25-gauge needle. The total volume was distributed evenly or proportionally depending on the area. No additional surgical stimulation occurred after the block, and extubation followed routine emergence from anesthesia.

Interventions

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Early Scalp Block Group

Following induction of general anesthesia and prior to head pinning (Mayfield clamp placement), a scalp block was performed under aseptic conditions using 20 mL of 0.25% bupivacaine.

The block targeted six sensory nerves that innervate the scalp: Supraorbital nerve, Supratrochlear nerve, Auriculotemporal nerve ,Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve.

Each nerve was infiltrated subcutaneously at its anatomical location using a 25-gauge needle, with the total volume distributed evenly or proportionally across the injection sites.

Intervention Type PROCEDURE

Late Scalp Block Group

In the pre-emergence group, the scalp block was performed at the end of surgery but before emergence from general anesthesia, while the patient was still under deep anesthesia.

Under strict aseptic conditions, 20 mL of 0.25% bupivacaine was administered to block the following six sensory nerves innervating the scalp: Supraorbital nerve, Supratrochlear nerve, Auriculotemporal nerve, Zygomaticotemporal nerve, Greater occipital nerve, Lesser occipital nerve.

The local anesthetic was injected subcutaneously at the anatomical landmarks of each nerve using a 25-gauge needle. The total volume was distributed evenly or proportionally depending on the area. No additional surgical stimulation occurred after the block, and extubation followed routine emergence from anesthesia.

Intervention Type PROCEDURE

Other Intervention Names

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Pre-pinning Scalp Block Group Pre-emergence Scalp Block Group

Eligibility Criteria

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Inclusion Criteria

* Patients aged between 18 and 80 years.
* Scheduled for craniotomy under general anesthesia.
* ASA physical status classification I to III.
* Glasgow Coma Scale (GCS) score of 15 at the time of emergence from anesthesia.
* Provide informed consent to participate in the study.

Exclusion Criteria

* Chronic use of analgesic medications prior to surgery.
* Glasgow Coma Scale (GCS) score below 15 postoperatively.
* Allergy or hypersensitivity to local anesthetics or opioids used in the study.
* Contraindications for scalp block or patient-controlled analgesia.
* Patients with severe hepatic, renal, or cardiac dysfunction.
* Patients unable to comprehend or complete the QoR-40 questionnaire.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sakarya University

OTHER

Sponsor Role lead

Responsible Party

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Muhammed Halit Tekeci, MD

Anesthesiology and Reanimation Specialist, M.D.

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Sakarya University Training and Research Hospital

Sakarya, , Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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Muhammed halit TEKECİ

Role: CONTACT

Phone: +905389334248

Email: [email protected]

Facility Contacts

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Muhammed Halit Tekeci, Specialist

Role: primary

Havva Kocayiğit, Assoc. Prof.

Role: backup

Other Identifiers

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E-43012747-050.04-474853246

Identifier Type: -

Identifier Source: org_study_id