Effect Of Multi-mode Analgesia In Craniotomy And Changes Of Calcitonin Gene-related Peptide

Objective:Clinical research shows that more than 80%of patients with craniotomy history have different degrees of postoperative pain experience,and more than 50%of them may also be accompanied by long-term chronic headache,perioperative analgesia may lead to anxiety,hypertension,more serious may lead to postoperative intracranial hemorrhage.Multi-mode analgesia is a new trend of clinical analgesia in recent years,which combines the advantages of different analgesia modes and reduces the side effects of single analgesia mode.The specific relationship between CGRP calcitonin gene-related peptide and pain is worth exploring.This study intends to discuss the observation of analgesic effect of multi-mode analgesia in neurosurgical craniotomy and the analysis of the possible relationship between CGRP and pain,so as to provide new ideas for clinical analgesia.Methods:Forty patients with elective craniotomy were selected.They were randomly divided into two groups,20 patients in the multi-mode analgesia group(group D)and 20 patients in the control group(group C).Both groups received intravenous anesthesia.In group D,bilateral Scalp nerve blocks were performed with 0.5%ropivacaine after anaesthesia induced intubation.Flurbiprofen Axetil Injection(50mg)was administered 10min before the upper three screws,followed by dural application of 2%lidocaine brain cotton after the surgical opening of the bone flap,0.1mg/kg dizocine 1 hour before the end of the surgery,and 1%lidocaine+0.375%ropivacaine after the skin suture for incision block.Butophanol 0.08-0.1mg/(kg.h)was intravenously pumped 24 hours after returning to the ward.In group C,bilateral scalp nerve block was performed with normal saline,and 0.1mg/kg dizocine was given 1 hour before the end of the operation.After returning to the ward,the same dose of normal saline was pumped.Records were recorded in the room,5min after endotracheal intubation,HR and MAP at the time of three nailing,skin cutting.The duration of surgery,intraoperative throughput,duration of extubation from the end of surgery to the patient's recovery,and total intraoperative dose of propofol and remifentanil were recorded.VAS scores were recorded 2h,12h and 24h postoperatively.The serum CGRP concentration was measured by 4ml venous blood of the patients 24 hours before and after anesthesia induction.The number of patients requiring additional analgesics after surgery was recorded.Results:1.There was no significant difference in preoperative general condition between the two groups(P>0.05).2.There was no significant difference in intraoperative throughput and operative duration between the two groups(P>0.05).3.Compared with group C,in group D,the dosage of propofol and remifentanil was less,and the difference was statistically significant(P<0.05).4.There was no significant difference in blood pressure and heart rate between the two groups before and during operation(P>0.05).5.The VAS scores in group D at T4?T5 and T6 were lower than group C,the difference was statistically significant(P<0.05).6.Compared with T0,the calcitonin gene-related peptide in group D and group C were both increased at T6,the difference was statistically significant(P<0.05).At T6 the calcitonin gene-related peptide in group C were higher than group D,the difference was statistically significant(P<0.05).7.Compared with group C,in group D,the number of patients who needed additional analgesic drugs after operation was significant reduced,and the difference was statistically significant(P<0.05).8.The extubation time in group D was earlier than group C,and the difference was statistically significant(P<0.05).Conclusion(s):We have found that after applying multi-mode analgesia in neurosurgical craniotomy,the intraoperative dosage of anesthetic drugs is less,the intraoperative vital signs are more stable,the postoperative recovery is faster,the number of additional analgesics is less,the postoperative VAS score is lower,and the CGRP concentration changes are smaller.Therefore,multi-mode analgesia can be safely applied to the clinic,making the intraoperative anesthesia management safer and effective,and reducing the pain and related complications of craniotomy patients.