Comparison of the analgesic effects of SCALP nerve block and intravenous ibuprofen applications under the guidance of nociception level index (NOL) in patients undergoing elective supratentorial craniotomy

Aim: Neurosurgery operations are among the surgeries with painful stimuli such as head-pinning, craniotomy, and intubation. Effective analgesic methods are needed for supratentorial craniotomy surgery that requires tight hemodynamic control. This study aimed to compare the effects of scalp nerve block and intravenous ibuprofen applications on nociception level (NoL) index monitoring and analgesic and hemodynamic changes. Materials and Method: This is a prospective, randomized, controlled, double-blind study with factorial groups. The study included one hundred two patients aged between 18-65, with a body mass index (BMI) below 30 and ASA I-III. The group in which intravenous (IV) ibuprofen was applied was named Ibuprofen group (I group), the group in which scalp nerve block was used Block group (B group), the group in which IV ibuprofen and scalp nerve block was applied Ibuprofen + Block group (IB group). Demographic parameters, changes in hemodynamic parameters, amount of remifentanil consumed, VAS value in the first 3 hours postoperatively, and frequency of nausea and vomiting were recorded. When the NoL value increased above 25, an IV bolus of 0.5 mcg/kg remifentanil was administered as a rescue analgesic. Results: A total of 102 patients, 54 (52.9%) female, and 48 (47.1%) male, were included in the study. The mean age of the patients participating in the study was 47.43±13.56. When the need for rescue analgesics was evaluated in patients with a NoL value above 25 during head-pinning, skin incision, and craniotomy, there was a difference between the groups, and none of the patients in the IB group needed rescue analgesics (p<0.001, p=0.002, p<0.001, respectively). For the amount of remifentanil consumed, the highest mean was found in the I group with 2042.65±752.28 mcg, the lowest mean was found in the IB group with 1250.00±418.69 mcg, and the mean was 1477.65±583.80 mcg in the B group. Sympathetic response in heart rate, systolic blood pressure, and diastolic blood pressure after intubation were significantly lower in group I and IB than in group B (respectively p=0.004, p=0.009, p<0.001). The sympathetic response seen in heart rate, systolic blood pressure, and diastolic blood pressure during head-pinning was significantly lower in group B and IB than in group I (p=0.033, p=0.012, p<0.001, respectively). VAS values at the 1st, 2nd, and 3rd hours were significantly lower in the B and IB groups than in the I group (p<0.001 and p<0.001, respectively). Conclusions: In elective supratentorial craniotomy, preemptive intravenous ibuprofen can provide hemodynamic stability during intubation, while hemodynamic stability can be achieved by scalp nerve block during head-pinning application. Intraoperative opioid consumption is reduced in patients who underwent scalp nerve block, and better pain control can be achieved in the early postoperative period.