Scalp block versus intravenous parecoxib for post-operative cranioplasty surgery pain: A comparison of pain scores and morphine requirements

Background: The cranioplasty surgery causes significant post-operative pain. Opioids are the first-line analgesic, but their side effects limit their use, thus favoring analgesia of the non-opioids group, such as non-steroidal anti-inflammatory drugs, scalp block, and paracetamol. We aimed to compare the post-cranioplasty pain scores between scalp block and conventional analgesia using intravenous (IV) parecoxib and morphine requirement as rescue analgesia. Methods: A double-blinded randomized controlled trial involved 42 patients who underwent elective cranioplasty into two groups: Scalp block ( n = 21) and IV parecoxib ( n = 21). After skin closure before reversal and extubation, these patients were given either a scalp block or IV parecoxib for analgesia. The post-operative pain score was recorded using a Visual Analogue Scale at 1, 2, 4, 6, and 12 h after surgery. Patient-controlled analgesia (PCA) morphine was given as rescue analgesia if the pain scores were equal to or >4. The side effects of the medication were recorded during a 12-h observation period post-operation. Results: Scalp block significantly reduced pain score at the 1 st , 2 nd , 4 th , and 6 th h of post-cranioplasty compared to the IV parecoxib group ( P = 0.000). The scalp block group had a lower percentage of patients needing PCA morphine (4.76% vs. 37.10%; P = 0.02). However, no difference in time to first commencement of PCA and total morphine dose was noted between the two groups. Conclusion: The scalp block reduced pain scores at the 1 st , 2 nd , 4 th , and 6 th h and morphine requirement postoperatively compared to IV parecoxib.