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      Journal of Pain Research (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on reporting of high-quality laboratory and clinical findings in all fields of pain research and the prevention and management of pain. Sign up for email alerts here.

      52,235 Monthly downloads/views I 2.832 Impact Factor I 4.5 CiteScore I 1.2 Source Normalized Impact per Paper (SNIP) I 0.655 Scimago Journal & Country Rank (SJR)

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      Pre-emptive scalp infiltration with dexamethasone plus ropivacaine for postoperative pain after craniotomy: a protocol for a prospective, randomized controlled trial

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          Abstract

          Background: Approximately 55–87% of the patients undergoing craniotomy experience moderate to severe pain during the first 48 hrs after surgery, which negatively influences patients’ postoperative rehabilitation. Recently, local infiltration of analgesia (LIA) has been widely performed clinically as a promising analgesic method that could avoid the side effects of analgesics but only has a short pain-free duration; researchers have clarified that the addition of dexamethasone to LIA could provide significant analgesic effects and significantly prolong the duration of analgesic effects without obvious complications for various types of surgeries. To date, no studies have evaluated the addition of dexamethasone to LIA for patients receiving craniotomy. The aim of the study was to test the hypothesis that pre-emptive scalp infiltration with a steroid (dexamethasone) plus a local anesthetic (ropivacaine) could achieve superior postoperative analgesic effects to a local anesthetic (ropivacaine) alone in adult patients undergoing a craniotomy.

          Study design and methods: This study is a randomized controlled trial that will include one intervention and one control group involving a total of 140 adults scheduled for elective craniotomy for resection of supratentorial tumors under general anesthesia and with an anticipated full recovery within 2 hrs postoperatively. The intervention will involve pre-emptive scalp infiltration with ropivacaine plus dexamethasone (the dexamethasone group) or ropivacaine alone (the control group), and the participants in both groups will complete a 6-month follow-up. The primary outcome will be the cumulative sufentanil consumption within 48 hrs postoperatively.

          Discussion: The intervention, if effective, this study will provide clinically important information on the role of dexamethasone in scalp infiltration for post-craniotomy pain management.

          Most cited references45

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          Controlled sedation with alphaxalone-alphadolone.

          M A Ramsay, T M Savege, B. R. Simpson … (1974)
          Alphaxalone-alphadolone (Althesin), diluted and administered as a controlled infusion, was used as a sedative for 30 patients in an intensive therapy unit. This technique allowed rapid and accurate control of the level of sedation. It had three particularly useful applications: it provided "light sleep," allowed rapid variation in the level of sedation, and enabled repeated assessment of the central nervous system.Sedation was satisfactory for 86% of the total time, and no serious complications were attributed to the use of the drug. Furthermore, though alphaxalone-alphadolone was given for periods up to 20 days there was no evidence of tachyphylaxis or delay in recovery time.
          Article 0 comments Cited 316 times – based on 0 reviews     Review now
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            A Review of Scar Scales and Scar Measuring Devices

            Regina Fearmonti, Jennifer Bond, Detlev Erdmann … (2010)
            Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments. Methods: This article reviews the literature on available tools and existent assessment scales used to subjectively and objectively characterize scar. Results: We describe the attributes and deficiencies of each tool and scale and highlight areas where further development is critical. Conclusion: An optimal, universal scar scoring system is needed in order to better characterize, understand and treat pathologic scarring.
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              Effects of steroids and retinoids on wound healing.

              C Wicke, Richard D M Allen, H Scheuenstuhl … (2000)
              Anti-inflammatory corticosteroids significantly impair wound healing. Retinoids partially, but significantly, reverse this effect. Little is known about the mechanism of steroid retardation or retinoid reversal. We hypothesized that corticosteroids lower transforming growth factor-beta (TGF-beta) and insulin-like growth factor-I (IGF-I) levels and tissue deposition in wounds and that retinoids stimulate corticosteroid-impaired TGF-beta and IGF-I release and collagen production. Randomized controlled trial. Wound healing research laboratory. Animal study. Four wire mesh wound cylinders were implanted subcutaneously into the backs of 72 male Sprague-Dawley rats. Wound healing was impaired by a single subcutaneous injection of 6 mg of methylprednisolone acetate (Depo-Medrol). Two preparations of retinoids were used in separate experiments: all-trans-retinoic acid and 9-cis-retinoic acid that were fed orally. Hydroxyproline content was measured in the healing tissue and TGF-beta and IGF-I levels were analyzed in the wound fluid. Methylprednisolone treatment significantly decreased TGF-beta and IGF-I levels in the wound fluid and hydroxyproline content in the tissue (P<.05). Oral all-trans- and 9-cis-retinoic acid partially reversed the TGF-beta and IGF-I decrease and significantly increased hydroxyproline content toward normal levels (P<.05). Oral all-trans-retinoic acid enhanced collagen deposition, TGF-beta and IGF-I levels over normal chow fed control animals (P<.05). Steroids and retinoids have antagonistic effects on growth factors and collagen deposition in wound healing. These effects can be relevant for treatment options in a clinical setting.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pain Res
                Journal ID (iso-abbrev): J Pain Res
                Journal ID (publisher-id): JPR
                Journal ID (pmc): jpainres
                Title: Journal of Pain Research
                Publisher: Dove
                ISSN (Electronic): 1178-7090
                Publication date (Electronic): 24 May 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 1709-1719
                Affiliations
                [1 ]Department of Anesthesiology and Pain Management, Beijing Tiantan Hospital, Capital Medical University
                [2 ]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
                [3 ]Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University , Beijing, People’s Republic of China
                Author notes
                Correspondence: Fang LuoDepartment of Pain Management, Beijing Tiantan Hospital, Capital Medical University , Beijing100050, People’s Republic of ChinaTel +860 106 709 6664Fax +860 106 705 0177Email 13611326978@ 123456163.com
                [*]

                These authors contributed equally to this work

                Article
                Publisher ID: 190679
                DOI: 10.2147/JPR.S190679
                PMC ID: 6542215
                PubMed ID: 31213883
                SO-VID: 4184fb0d-fe60-48b0-a961-d2ebac5d06b3
                Copyright © © 2019 Jia et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 12 October 2018
                Date accepted : 18 March 2019
                Page count
                Figures: 1, Tables: 1, References: 47, Pages: 11
                Categories
                Subject: Study Protocol

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: postoperative pain,craniotomy,pre-emptive scalp infiltration,dexamethasone,sufentanil consumption
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: postoperative pain, craniotomy, pre-emptive scalp infiltration, dexamethasone, sufentanil consumption

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