Combined opioid free and scalp block enhances the quality of recovery in supratentorial craniotomies done under ERAS protocol: A prospective case series

• Author Details:   
• Kumud S Ganvit
• Pinal Raj Bumiya ^*
• Pampaniya Vishvaben Dhanabhai
• Ankit Shah

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Post-craniotomy pain is often severe and poorly managed, leading to the exploration of alternatives to opioid-based anaesthesia. While it is a standard practice in neurosurgery, opioid-based anaesthesia can interfere with neurological monitoring and cause side effects. In a case series of ten supratentorial craniotomy patients, we implemented an Enhanced Recovery After Surgery (ERAS) protocol, utilizing opioid-free anaesthesia (OFA) with injections of Magnesium Sulfate and Dexmedetomidine, complemented by a scalp block for a multimodal analgesic approach. The primary outcomes included total postoperative analgesia duration and hemodynamic stability, while secondary outcomes assessed extubation time, rescue analgesic requirements, postoperative nausea and vomiting, sedation levels, and any other complications. The ERAS protocol with opioid-free anaesthesia (OFA) demonstrated excellent recovery outcomes, including rapid extubation, an average analgesia duration of 23 hours, minimal Visual Analog Scale (VAS) scores, low demand for rescue analgesics, minimal sedation, and no postoperative nausea, vomiting, or other complications, highlighting its potential as an effective method for expedited recovery.

Keywords: Supratentorial craniotomies, Opioid free anaesthesia, ERAS.