# Evaluating the Efficacy of Ropivacaine Instillation Through a Subgaleal Drain for Postcraniotomy Pain: A Randomized Controlled Trial

## TL;DR

This study found that using 0.2% ropivacaine through a subgaleal drain after craniotomy significantly reduces postoperative pain and analgesic use compared to lower concentrations or saline.

## Contribution

The study introduces a novel method of postcraniotomy pain management using ropivacaine instillation through a subgaleal drain.

## Key findings

- 0.2% ropivacaine provided significantly lower pain scores at multiple time points compared to 0.1% ropivacaine and saline.
- The duration of analgesia was significantly longer with 0.2% ropivacaine compared to the other groups.
- 0.2% ropivacaine required less rescue analgesia than the other groups.

## Abstract

Background: The majority of patients experience moderate to severe postcraniotomy pain, which causes several complications such as raised intracranial pressure, cerebral hemorrhage, chronic headache, etc. Therefore, this study aimed to assess the efficacy of ropivacaine instillation through subgaleal drain in patients undergoing elective craniotomy to reduce postcraniotomy pain. The primary objective of this study was to assess postoperative pain after craniotomy using the Numeric Rating Scale (NRS) score.

Materials and methods: A prospective, double-blinded, randomized controlled study was conducted in 120 patients posted for elective craniotomy, randomly allocated into three groups. Group A (n = 40) received 12 mL of 0.9% normal saline, Group B (n = 40) received 12 mL of 0.1% ropivacaine, and Group C (n = 40) received 12 mL of 0.2% ropivacaine. Postoperative NRS score, duration of analgesia, amount of rescue analgesia, patient satisfaction score, and hemodynamic parameters were compared in 24 hours among the three groups.

Results: The NRS score was lowest in Group C compared to Group A and Group B at all time points, with significant differences observed at 30 minutes, 45 minutes, one hour, and two hours after drug instillation. The duration of analgesia was significantly prolonged in Group C (489.24 ± 204.5 minutes) compared to Group B (112.7 ± 156.5 minutes) and shortest in Group A (43.87 ± 24.2 minutes). The amount of rescue analgesic required was least in the 0.2% ropivacaine group (103.12 ± 36.3 mg) compared to the 0.1% ropivacaine group (144.37 ± 48.5 mg). It was in a substantial amount in the 0.9% normal saline group (176.2 ± 61.7 mg).

Conclusions: We concluded that for postcraniotomy pain, a single-dose 0.2% ropivacaine drug installation at the end of surgery through a surgical (subgaleal) drain had better pain control, a longer duration of analgesia, and a lower analgesic requirement compared to 0.1% ropivacaine and 0.9% normal saline.