A Study of efficacy of Ropivacaine Instillation Through Subgaleal Drain for Post Craniotomy Pain Management A Randomized Controlled Trial

Post-craniotomy pain is frequently underestimated, yet evidence shows that most patients experience moderate to severe pain in the first 24 hours after surgery. Effective analgesia is essential, but the use of opioids and sedatives is limited because they can interfere with the neurological assessments required after brain surgery. Therefore, a safe, localized method of pain relief is needed.

This randomized controlled trial aims to evaluate the analgesic efficacy of instilling 15 mL of 0.25% Ropivacaine through the subgaleal drain—a space already created during craniotomy. This technique targets the innervated scalp tissues directly, offering localized analgesia with minimal systemic effects.

A total of 46 adult patients, undergoing elective supratentorial craniotomy, will be randomly assigned into two groups:

• Group R: Subgaleal instillation of Ropivacaine
• Group P: Standard IV Paracetamol 15 mg/kg every 6 hours

Postoperative monitoring will include VAS pain scores, time to first rescue analgesia, total analgesic use, sedation scores (RASS), recovery scores (Modified Aldrete), and adverse events such as nausea/vomiting. Rescue analgesia will be provided when VAS > 4.

The study aims to determine whether ropivacaine instillation provides better pain relief, prolongs time to rescue analgesia, reduces overall analgesic consumption, and enhances postoperative recovery, without affecting neurological evaluation.