BACKGROUND The efficacy of superficial cervical plexus blocks for reducing persistent pain after craniotomies remains unclear. We therefore tested the primary hypothesis that preoperative ultrasound-guided superficial cervical plexus blocks reduce persistent pain 3 months after suboccipital craniotomies. METHODS We conducted a single-center randomized and blinded parallel-group trial. Eligible patients having suboccipital craniotomies were randomly allocated to superficial cervical plexus blocks with 10 ml of 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 Nov 2021 to August 2023, 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 years and the duration of surgery was 4.2±1.3 hours. 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. CONCLUSION Superficial cervical plexus blocks reduce the incidence of persistent incisional pain by about a third in patients recovering from suboccipital craniotomies.

中文翻译：

---

超声引导下颈浅丛神经阻滞治疗枕下开颅术后持续性疼痛：一项随机试验。


背景 颈浅丛阻滞对于减轻开颅手术后持续性疼痛的功效仍不清楚。因此，我们测试了主要假设，即术前超声引导的浅表颈丛神经阻滞可减轻枕下开颅手术后 3 个月的持续性疼痛。方法 我们进行了一项单中心随机、盲法平行组试验。符合枕下开颅术的患者被随机分配至颈浅丛神经阻滞组，使用 10 ml 0.5% 罗哌卡因或相当量的生理盐水。注射进入椎前筋膜的浅层。主要结果是术后三个月持续疼痛的发生率。结果 从 2021 年 11 月到 2023 年 8 月，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，手术持续时间为4.2±1.3小时。随机接受罗哌卡因治疗的患者中有 48 名 (34%) 报告术后 3 个月出现持续性疼痛，而接受生理盐水治疗的患者则有 73 名 (51%) 报告出现术后 3 个月持续疼痛（相对风险 0.66；95% CI，0.50 至 0.88；P = 0.003）。 - 方案人群中，随机接受罗哌卡因治疗的患者有 53 名 (36%)，而接受生理盐水治疗的患者有 77 名 (53%)（相对风险 0.69，95% CI，0.53 至 0.90；P = 0.005）对待人口。结论 颈浅丛阻滞可使枕下开颅手术恢复期患者持续性切口痛的发生率降低约三分之一。