Use of regional scalp block for pain management after craniotomy: Review of literature and critical appraisal of evidence.

BACKGROUND: The effective management of postoperative pain have the tendency to reduce morbidity and mortality. According to International Association for the Study of Pain (I.A.S.P), pain is an unpleasant sensory and emotional experience associated with existing or potential tissue injury. Post-operative pain is most severe during the first 72h following surgery and is usually of limited time frame mostly.

METHODS: Literature search conducted using EMBASE (1980 onwards), MEDLINE (1946 onwards) and Cochrane Central register of Controlled Trials database for systematic reviews. Key words applied were "scalp block" "craniotomy" "analgesia", "neurosurgery". Studies were limited to English and those involving humans. Relevant studies were isolated for further critique and the level of evidence assessed.

RESULTS: Total of 140 citations were identified, after thorough screening non relevant studies and non-randomised clinical trials were exempted, five randomised control trials selected. Selection not restricted by English language.

CONCLUSION: The evidences are very limited, most data are confounded by weaknesses in methodology and most of the studies have small sample sizes. Large trials on safety and efficacy of analgesia post craniotomy using standardized and widely accepted tools are yet to be performed. None of the studies identified studied post craniotomy analgesia in patients with neurocognitive change. From level 1 evidence, regional scalp block post craniotomy provides effective form of analgesia.