Pre-emptive Scalp Infiltration With Methylprednisolone Plus Ropivacaine for Postoperative Pain After Craniotomy
Pre-emptive Scalp Infiltration With Methylprednisolone Plus Ropivacaine for Postoperative Pain After Craniotomy
Pain is common for the first 2 days after major craniotomy. A majority of patients would
 suffer from moderate-to-severe postoperative pain after undergoing craniotomy. Inadequate
 analgesia induced sympathetically mediated hypertension may lead to an increased risk for
 post-operative complications. Adequate pain control is essential for patients' prognosis and
 their postoperative life quality. Pain after craniotomy derives from the scalp and
 pericranial muscles. Local anesthetics administered around the incision have been performed
 clinically. However, some studies revealed that the analgesic effect of local anesthetics was
 not unsatisfactory due to its short pain relief duration. Pain is common for the first 2 days
 after major elective intracranial surgery, and the relatively short analgesic time of scalp
 infiltration does not seem to meet the requirements of craniotomy. Steroid such as
 methylprednisolone as an adjuvant to local anesthetics intra-articular injected locally
 reduced pain intensity after total knee arthroplasty or lumbar discectomy. However, there has
 not been reported about local application of methylprednisolone on scalp infiltration. Thus,
 the investigators suppose that pre-emptive scalp infiltration with steroid
 (methylprednisolone) plus local anesthetic (ropivacaine) could relieve postoperative pain
 after craniotomy in adults.
Inclusion Criteria:

 -  Patients scheduled for elective craniotomy for resection of tumour under general
 anaesthesia;

 -  American Society of Anesthesiologists (ASA) physical status of I , II or III;

 -  Participates with an anticipated fully recovery within 2 hours postoperatively.

 Exclusion Criteria:

 -  History of craniotomy;

 -  Expected delayed extubation or no plan to extubate;

 -  Participants who cannot use a patient-controlled analgesia (PCA) device;

 -  • Participants who cannot understand the instructions of a numeral rating scale (NRS)
 35 before surgery;

 -  Extreme body mass index (BMI) (< 15 or > 35);

 -  Allergy to opioids, methylprednisolone or ropivacaine;

 -  History of excessive alcohol or drug abuse, chronic opioid use (more than 2 weeks), or
 use of drugs with confirmed or suspected sedative or analgesic effects;

 -  History of psychiatric disorders, uncontrolled epilepsy or chronic headache;

 -  Pregnant or at breastfeeding;

 -  Symptomatic cardiopulmonary, renal, or liver dysfunction or history of diabetes;

 -  Preoperative Glasgow Coma Scale< 15;

 -  Suspicion of intracranial hypertension;

 -  Peri-incisional infection;

 -  Participants who have received radiation therapy and chemotherapy preoperatively or
 with a high probability to require a postoperative radiation therapy and chemotherapy
 according to the preoperative imaging.