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- DOI 10.18231/j.ijca.2025.082
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CrossMark
Combined opioid free and scalp block enhances the quality of recovery in supratentorial craniotomies done under ERAS protocol: A prospective case series
- Author Details:
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Kumud S Ganvit
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Pinal Raj Bumiya *
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Pampaniya Vishvaben Dhanabhai
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Ankit Shah
Pinal Raj Bumiya *
Pampaniya Vishvaben Dhanabhai
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.
References
- Kaushal A, Haldar R. Regional Anesthesia in Neuroanesthesia Practice. Discoveries. 2020;8(2):e111.
- Sohn HM, Kim BY, Bae YK, Seo WS, Jeon YT. Magnesium sulfate enables patient immobilization during moderate block and ameliorates the pain and analgesic requirements in spine surgery, which can not be achieved with opioid-only protocol: A randomized double-blind placebo-controlled study. J Clin Med. 2021;10(19):4289.
- Ibrahim M, Elnabtity AM, Hegab A, Alnujaidi OA, El Sanea O. Combined opioid free and loco-regional anaesthesia enhances the quality of recovery in sleeve gastrectomy done under ERAS protocol: a randomized controlled trial. BMC Anesthesiol. 2022;22(1):29.
- Khozenko A, Lamperti M, Velly L, Simeone P, Tufegdzic B. Role of anaesthesia in neurosurgical enhanced recovery programmes. Best Pract Res Clin Anaesthesiol. 2021;35(2):241–53.
- Darmawikarta D, Sourour M, Couban R, Kamath S, Reddy KKV, Shanthanna H. Opioid-Free Analgesia for Supratentorial Craniotomies: A Systematic Review. Can J Neurol Sci. 2019;46(4):415–22.
- Sarma R, Gupta N, Kumar V, JeeBharati S. Opioid-free anesthesia for patient undergoing breast cancer surgery: A case series. Med J Dr DY Patil Vidyapeeth. 2022;15(3):418–20.
- Salem AK, Ragab SG, Mahmoud AM. Effectiveness of magnesium sulfate on the smoothness of extubation in patients undergoing general anesthesia with endotracheal intubation: a randomized controlled trial. Egypt J Cardiothorac Anesth. 2022;16(1):1.
- Choudhary N, Bhalotra A, Magoon R. The role of magnesium in perioperative management of intracranial aneurysm surgery: A case series. Saudi J Anaesth. 2021;15(2):219–21.
- Nasr YM, Waly SH, Morsy AA. Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants. Egypt J Anaesth. 2020;36(1):7–15. 538 Ganvit et al. / Indian Journal of Clinical Anaesthesia 2025;12(3):534–538
- Mahajan C, Mishra R, Jena B, Kapoor I, Prabhakar H, Rath G, et al. Effect of magnesium and lignocaine on post-craniotomy pain: A comparative, randomized, double blind, placebo-controlled study. Saudi J Anaesth. 2019;13(4):299–305.
- Gupta L, Agarwal J, Saxena KN. Opioid-free anaesthesia: The conundrum and the solutions. Indian J Anaesth. 2022;66(Suppl 2):S91-S4.
- Sriganesh K, Singh G, Bidkar PU, Sethuraman M, Moningi S. Non- opioid versus opioid peri-operative analgesia in neurosurgery (NOPAIN): Study protocol for a multi-centric randomised controlled trial. Indian J Anaesth. 2023;67(10):920–6.