Scalp Blocks Effect on Postoperative Nausea & Vomiting After Craniotomy

Not Applicable

Completed

Brief Summary: In this study, the investigators hypothesize that preemptive scalp block in neurosurgical patients may decrease incidence of PONV after craniotomy through decreasing intraoperative inhalational agents' concentration and decreasing intraoperative opioids requirements, with better intraoperative hemodynamics and lesser recovery time

Detailed Description: Patients will be recruited after admission to the hospital for surgery. Randomization will be performed using computer-generated random number tables in opaque sealed envelopes prepared by an anesthesiologist who will be not part of the study

Patients will be randomly divided into two groups using a computer generated random number chart. Group S received scalp block with 20 ml of 0.5% bupivacaine, whereas Group C received scalp block using 20 mL normal saline and will be considered as control group.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

patients under 18 years of age,
pregnancy,
emergency surgery,
patients with a Glasgow Coma Score (GCS) less than 15,
those with documented allergy to bupivacaine,
regular communication not possible,
Patients requiring prolonged mechanical ventilation (> 2 hours after end of surgery) will be also excluded

Arm && Interventions

Group	Intervention	Description
Group S	Scalp block	Group S received scalp block with 20 ml of 0.5% bupivacaine
Group C	Control Group	Group C will not have any intervention

Primary Outcome Measures

Name	Time	Method
PONV incidence & severity during the 1st 24 hours in ICU.	24 hours	The intensity of the PONV was classified as: 0: without PONV, 1: nausea, 2: vomiting and 3: vomiting more than 2 times \[8\]. In addition, the incidence of PONV, the first time there was need for ondansetron and its total dose was recorded. With PONV score ≥ 2, the investigators used 4 mg ondansetron IV for antiemetic regimen. The total dose over 24 hours (given as divided doses) must not exceed adult dose of 32 mg.

Secondary Outcome Measures

Name	Time	Method
Total intraoperative fentanyl consumption in microgram	6 hours	The bolus dose given at skin incision was not included
Recovery time in minutes	10 minutes	It is the time interval between discontinuation of isoflurane and extubation
Intraoperative Mean blood pressure in mmHg	6 hours	Mean blood pressure will be measured at specific timing coded as follows: Tzero: mean blood pressure will be measured preoperatively as baseline T1: mean blood pressure will be measured after intubation T2: mean blood pressure will be measured after scalp block T3: mean blood pressure will be measured during pinning T4: mean blood pressure will be measured at skin incision Then mean blood pressure will be measured every 15 min for 1 hour, and every 1 hour till end of surgery T-end: mean blood pressure will be measured at skin closure
Intraoperative Heart rate as number of beats per minute	6 hours	Heart rate will be measured at specific timing coded as follows: Tzero: Heart rate will be measured preoperatively as baseline T1: Heart rate will be measured after intubation T2: Heart rate will be measured after scalp block T3: Heart rate will be measured during pinning T4: Heart rate will be measured at skin incision Then Heart rate will be measured every 15 min for 1 hour, and every 1 hour till end of surgery T-end: Heart rate will be measured at skin closure

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