Comparison of Systemic Opioid (Morphine) and Pre-Incision Bilateral Scalp Nerve Block for Pain Management in Craniotomy Patients

Summary

The goal of this randomized controlled clinical trial is to compare the effectiveness of systemic opioids versus pre-incision bilateral scalp nerve block in managing intraoperative noxious stimuli and postoperative pain in adult patients (18-75 years) undergoing elective supratentorial craniotomy.

The main questions this study aims to answer are:

Does pre-incision bilateral scalp nerve block provide better intraoperative hemodynamic stability compared to systemic opioids?

Does it result in lower postoperative pain scores and reduced opioid consumption during the first 24 hours after surgery?

Researchers will compare Group M (systemic morphine) with Group S (bilateral scalp nerve block) to see if the scalp nerve block offers superior analgesia and fewer opioid-related side effects.

Participants will:

Be randomly assigned to receive either systemic morphine or bilateral scalp nerve block before incision.

Undergo standard general anesthesia for craniotomy.

Have postoperative pain managed using a patient-controlled analgesia (PCA) morphine pump and be monitored for 24 hours for pain, sedation, and nausea/vomiting scores

Conditions

• Supratentorial Tumors

Interventions

PROCEDURE

Scalp nerve block

Bilateral block of the following nerves: * Supraorbital nerve * Supratrochlear nerve * Auriculotemporal nerve * Zygomaticotemporal nerve * Greater occipital nerve * Lesser occipital nerve

DRUG

Morphine

Drug: Morphine Dose: 0.1 mg/kg Route: Intravenous Timing: At induction of anesthesia

DRUG

Lidocaine

Concentration: 0.1% Route: Local infiltration Used as part of scalp block mixture

DRUG

Ropivacaine

Concentration: 0.25% Route: Local infiltration Used as part of scalp block mixture

DRUG

Epinephrine (Adrenaline)

Concentration: 1:200,000 Route: Local infiltration Used as vasoconstrictor adjunct

DRUG

Dexamethasone

Dose: 4 mg Route: Local Infiltration Used as adjunct to prolong block duration

Sponsors & Collaborators

• Aga Khan University

  lead OTHER

Principal Investigators

• Dileep Kumar, MBBS, FCPS · Aga Khan University

Study Design

Allocation

RANDOMIZED

Purpose

SUPPORTIVE_CARE

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

75 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2025-01-01

Primary Completion

2025-07-01

Completion

2025-09-30

Countries

• Pakistan

Study Locations