Noor Syamsu Komarulloh
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Christrijogo Soemartono Waloejo
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Prananda Surya Airlangga
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Bambang Pujo Semedi
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Dhania A. Santosa
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Dedi Susila
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Belindo Wirabuana
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Pricilia Desiree
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Ovi Octavia Karamoy
Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
Moses Glorino Rumambo Pandin
Faculty of Cultural Science, Universitas Airlangga, Surabaya, Indonesia
ABSTRACT
PGE2 is a pain mediator with the greatest effect on the process of postoperative pain. Craniotomy causes significant postoperative pain that leads to poor patient outcomes if it is insufficiently managed. Scalp nerve block with ropivacaine as pre-emptive analgesia can optimize postoperative pain management. Ropivacaine inhibits the transmission of painful stimuli from peripheral nociceptors and prevents the production of PGE2 from the surgical site. This study aimed to analyze the impact of scalp nerve block with ropivacaine, given as pre-emptive analgesia, on PGE2 levels and pain intensity among elective craniotomy patients. A prospective analytical-experimental study was conducted on elective craniotomy patients at RSUD Dr. Soetomo from October to November 2023. 40 subjects were divided equally into two groups: Scalp Nerve Block (SNB) group and Non-Scalp Nerve Block (non-SNB) group. The SNB group received a scalp injection with 0.5% ropivacaine after induction of general anesthesia, the non-SNB group only received general anesthesia. PGE2 levels were analyzed before surgical incision, 6 hours after incision, and 24 hours after the completion of surgery. Pain intensity was measured with CPOT score at 24 hours after surgery. PGE2 levels in the SNB group was significantly lower at 6 hours after incision compared to the non-SNB group [100.82 (71.38-426.490) pg/mL vs 194.98 (72.38-542.49) pg/mL; p=0.009]. CPOT score at 24 hours after surgery was significantly lower in the SNB group [1 (0-3) vs 2 (0-3); p=0.017]. There was no significant correlation between PGE2 level and CPOT score (r=0.136; p=0.404). SNB with ropivacaine as pre-emptive analgesia could suppress the elevation of PGE2 up to 6 hours after incision and reduce pain intensity up to 24 hours after surgery. PGE2 levels at 24 hours after surgery remained at high levels and were not correlated with pain intensity.
Keywords: Scalp Nerve Block, Pre-Emptive Analgesia, Ropivacaine, Craniotomy, PGE2, Pain Intensity, CPOT.
