A Comparative Study On The Effects Of Ultrasound-guided Proximal Approach And Body Surface Marking Methods Of Greater Occipital And Lesser Occipital Nerve Block

Objective: To observe whether the analgesic effect of ultrasound-guided proximal approach of greater occipital and lesser occipital nerve block on the posterior occipital region after craniotomy in the Department of Craniocerebral Surgery is better than that of body surface marking methods of greater occipital and lesser occipital nerve block.Methods: The patients selectively receiving craniotomy of the posterior occipital region were randomly divided into ultrasound group(Group U)and body surface marking group(group B)at 1:1.Both groups underwent scalp nerve block using 0.5% ropivacaine.Greater occipital and lesser occipital nerve block were performed after entering the operating room in the group U under ultrasound guidance,while the group B was blocked using the traditional method.After blocking for 15 min,the block effect was evaluated by acupuncture,and then endotracheal intubation was performed under general anesthesia.The main outcome measure was visual analogue scale(VAS)score at 12h,18h,24h,36 hand 48h after blocking.Secondary outcome measures included the blockeffect after block for 15 min,changes in MAP and HR before and after skin incision,during drilling and epidural opening,dosage of analgesics and vasoactive drugs during surgery,and use of additional analgesics after surgery.The incidence of nausea,vomiting and other adverse reactions were recorded after surgery.Results: The VAS score of the two groups at each time point were all higher than that at 12h after block,and the VAS scores at 18h,24h after block were significantly higher than those in the group B(P>0.05).There was no significant difference in the success rate between the two groups 15 min after block(P>0.05).There was no significant differrence in MAP and HR between the two groups at each time point(P>0.05).There was no significant difference in the dosage of various anesthetics or vasoactive drugs between the two groups(P>0.05).The postoperative dosage of additional analgesics presented a statistically significant difference between the two groups(P<0.05).There was no significant difference in the number of cases of addition alanalgesic between the two groups(P>0.05)There were no significant differences in the incidences of postoperative nausea,vomiting and other adverse reactions between the two groups(P>0.05).Conclusions: Compared with the body surface marking methods of greater occipital and lesser occipital nerve block,ultrasound-guided proximal approach of greater occipital and lesser occipital nerve block can provide better postoperative analgesia for patients undergoing craniotomyin the posterior occipital region,and reduce the dosage of postoperative analgesic drugs.