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- Title
Cost-effectiveness and efficacy of scalp block for elective supratentorial craniotomy in resource-limited settings: A randomized controlled trial.
- Authors
Kitsiripant, Chanatthee; Boonyamarn, Aunchitha; Oofuvong, Maliwan; Prathep, Sumidtra; Kaewborisutsakul, Anukoon
- Abstract
Background: Remifentanil is favored for neurosurgical pain management, but its utilization in low- and middleincome countries (LMICs) is limited. Scalp block techniques are effective in LMICs, but cost-effectiveness is uncertain. This study compares costs and perioperative outcomes of scalp block versus fentanyl infusion in patients undergoing elective supratentorial craniotomy. Methods: A prospective double-blind randomized controlled trial was conducted with 36 patients aged 18-65 years undergoing elective supratentorial craniotomy. Patients were randomly assigned to receive either scalp block with 0.5% bupivacaine (Group S) or fentanyl infusion (Group F), with normal saline placebo administered in both groups. The primary endpoint was the anesthetic costs, with secondary endpoints including perioperative opioid consumption, intraoperative hemodynamic changes, and perioperative complications. Results: The cost of fentanyl was significantly lower than that of local anesthetics (3.31 [3.31, 3.75] vs. 4.27 [4.27, 4.27] United States dollars, P < 0.001). However, the overall anesthetic cost did not differ significantly between groups. Group F demonstrated a significant reduction in mean arterial pressure immediately and 5 min after pin insertion compared to Group S (75.8 [13.9] vs. 92.5 [16.9] mmHg, P = 0.003 and 67.7 [6.4] vs. 78.5 [10.7] mmHg, P < 0.001, respectively). Conclusion: Fentanyl infusion presents cost advantages over scalp block in LMIC settings. However, prudent opioid use is imperative. This study underscores the need for ongoing research to optimize neurosurgical pain management and evaluate long-term safety implications.
- Subjects
RESOURCE-limited settings; SURGICAL complications; LOCAL anesthetics; MIDDLE-income countries; FENTANYL; CRANIOTOMY
- Publication
Surgical Neurology International, 2024, Vol 15, p1
- ISSN
2229-5097
- Publication type
Article
- DOI
10.25259/SNI_255_2024