Opioid-Free Total Awake Craniotomy and Cortical Mapping: Our Experience

Background: Awake craniotomy is the preferred technique in surgeries involving eloquent areas of brain. Primary aim of anesthesia management is to provide awake and cooperative patient facilitating functional and neurophysiological monitoring for cortical mapping. Although opioids have minimal effect on neurophysiological monitoring, the side effects, like drowsiness, respiratory depression, itching, chest wall rigidity, nausea, and vomiting, can interfere with patient cooperation. We studied the feasibility of excluding opioids in anesthetic management of awake craniotomy and assessed the patient’s response, cooperation, and comfort during the procedure in a series of patients.

Materials and Methods: From January 2019 opioid free anesthetic management was introduced in awake craniotomies in our institute. Age less than 18 years and more than 65 years, ASA III and above, expected surgery duration more than 6 hours, and any comorbidity that warranted asleep–awake–asleep technique were excluded. Data regarding anesthesia management, drugs used, patient cooperation, need for additional anesthetic agents, feasibility of neurophysiological monitoring, and duration of scalp block were collected.

Results: Eight patients met inclusion criteria. Bilateral scalp block was provided with 12 mL of bupivacaine0.5%, Mayfield pin site infiltration was done with 3 mL of bupivacaine 0.5%. Paracetamol 1 gm was given intravenously before scalp incision. Gauze soaked with lignocaine 2% was placed on the dura mater for 3 minutes before incision. All patients were cooperative for functional assessment including language mapping. Satisfactory signals were obtained from neurophysiological monitoring. Mean duration of first perception of surgical site pain was 7 ± 1 hours.

Conclusions: Our case series highlights that total awake craniotomy can be successfully managed with adequate scalp block and paracetamol as preemptive analgesic agents. Opioids can be spared during awake craniotomy management thus minimizing opioid related side effects and without affecting the intraoperative functional monitoring.

Publikationsverlauf

Artikel online veröffentlicht:
25. März 2020