Ultrasound-Guided Occipital Nerve Blocks as Part of Multi-Modal Perioperative Analgesia in Pediatric Posterior Craniotomies: A Case Series

Various regional anesthetics have been used for postoperative analgesia for pediatric craniotomy. In this case series, we report retrospectively collected data on postoperative pain and analgesic use in 44 patients who received ultrasound-guided occipital nerve blocks in addition to intravenous analgesic agents for posterior craniotomy procedures. In the immediate post-anesthesia care unit, pain was rated as zero or well controlled in 77% of patients, with only 43% requiring intravenous or demand patient-controlled analgesia opioids. There were no block-related complications. Occipital nerve blocks may constitute a safe and effective component of multimodal analgesia in this population.

[1]  Xiang Li,et al.  Scalp block for postoperative pain after craniotomy: A meta-analysis of randomized control trials , 2022, Frontiers in Surgery.

[2]  Lai Jiang,et al.  Effect of scalp nerve block with ropivacaine on postoperative pain in pediatric patients undergoing craniotomy: A randomized controlled trial , 2022, Frontiers in Medicine.

[3]  I. Yang,et al.  Selective scalp block decreases short term post-operative pain scores and opioid use after craniotomy: A case series , 2021, Journal of Clinical Neuroscience.

[4]  M. LoPresti,et al.  Intrawound Liposomal Bupivacaine in Pediatric Chiari Decompression: A Retrospective Study , 2021, Pediatric quality & safety.

[5]  V. Ban,et al.  Multimodal analgesia for craniotomy. , 2019, Current opinion in anaesthesiology.

[6]  A. Dubrovsky Nerve Blocks in Pediatric and Adolescent Headache Disorders , 2017, Current Pain and Headache Reports.

[7]  F. Bilotta,et al.  Postoperative Pain Control Following Craniotomy: A Systematic Review of Recent Clinical Literature , 2017, Pain practice : the official journal of World Institute of Pain.

[8]  Jason S. Eldrige,et al.  Clinical Efficacy of an Ultrasound-Guided Greater Occipital Nerve Block at the Level of C2 , 2016, Regional Anesthesia & Pain Medicine.

[9]  K. Barlow,et al.  Occipital Nerve Blocks for Pediatric Posttraumatic Headache , 2015, Journal of child neurology.

[10]  T. A. Anderson,et al.  Ultrasound-guided peripheral nerve blocks for ventricular shunt revision in children. , 2014, A & A case reports.

[11]  M. Rota,et al.  Incidence of pain after craniotomy in children , 2014, Paediatric anaesthesia.

[12]  A. Davidson,et al.  Post-Craniotomy Pain in a Paediatric Population , 2011, Anaesthesia and intensive care.

[13]  A. Gelb,et al.  Acute and chronic pain following craniotomy , 2010, Current opinion in anaesthesiology.

[14]  Richard E Thompson,et al.  Prospective evaluation of pain and analgesic use following major elective intracranial surgery. , 2007, Journal of neurosurgery.

[15]  S. Verbrugge,et al.  Pain in neurosurgically treated patients: a prospective observational study. , 2006, Journal of neurosurgery.

[16]  S. Suresh,et al.  Regional Anesthesia in a Very Low-Birth-Weight Neonate for a Neurosurgical Procedure , 2003, Regional Anesthesia & Pain Medicine.

[17]  M. Bojanowski,et al.  Scalp Nerve Blocks Decrease the Severity of Pain After Craniotomy , 2001, Anesthesia and analgesia.

[18]  N. Morton,et al.  Prevention and control of pain in children. , 1999, British journal of anaesthesia.