BACKGROUND The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. The authors tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies. METHODS A single-center randomized and blinded parallel-group trial was conducted. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml 0.5% ropivacaine or a comparable amount of normal saline. Injections were into the superficial layer of prevertebral fascia. The primary outcome was the incidence of persistent pain three months after surgery. RESULTS From November 2021 to August 2023, a total of 292 qualifying patients were randomly allocated to blocks with ropivacaine (n = 146) or saline (n = 146). The average ± SD age of participating patients was 45 ± 12 yr, and the duration of surgery was 4.2 ± 1.3 h. Persistent pain 3 months after surgery was reported by 48 (34%) of patients randomized to ropivacaine versus 73 (51%) in those assigned to saline (relative risk, 0.66; 95% CI, 0.50 to 0.88; P = 0.003) in the per-protocol population, and by 53 (36%) of patients randomized to ropivacaine versus 77 (53%) in those assigned to saline (relative risk, 0.69; 95% CI, 0.53 to 0.90; P = 0.005) in the intention-to-treat population. CONCLUSIONS Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies. EDITOR’S PERSPECTIVE

中文翻译：

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超声引导下颈浅丛神经阻滞治疗枕下开颅手术后持续性疼痛：一项随机试验。


背景 浅表颈丛阻滞对减轻开颅手术后持续疼痛的疗效尚不清楚。作者检验了术前超声引导下浅表颈丛阻滞可减轻枕下开颅术后 3 个月持续疼痛的主要假设。方法 进行一项单中心随机和盲法平行组试验。符合条件的枕下开颅手术患者被随机分配到使用 10 ml 0.5% 罗哌卡因或类似量的生理盐水的浅表颈丛阻滞组。注射到椎前筋膜的浅层。主要结局是术后 3 个月持续疼痛的发生率。结果 从 2021 年 11 月到 2023 年 8 月，共有 292 名符合条件的患者被随机分配到罗哌卡因 （n = 146） 或生理盐水 （n = 146） 组。参与患者的平均 ± SD 年龄为 45 ± 12 岁，手术时间为 4.2 ± 1.3 小时。随机分配至罗哌卡因组的患者中有 48 名 （34%） 报告术后 3 个月持续疼痛，而分配到盐水组的患者中有 73 名 （51%） 报告了手术后持续性疼痛（相对风险，0.66;95% CI，0.50 至 0.88;P = 0.003），以及随机分配至罗哌卡因组的 53 名 （36%） 患者与分配到生理盐水组的患者中的 77 名 （53%） （相对风险，0.69;95% CI，0.53 至 0.90;P = 0.005）。结论 颈浅丛阻滞可将枕下开颅手术恢复患者持续性切口疼痛的发生率降低约 1/3。编辑观点