Application Of Scalp Nerve Block In Intracranial Electrode Implantation Assisted By ROSA Robot

ObjectiveTo explore the application method and effect evaluation of scalp nerve block in intracranial electrode implantation assisted by ROSA robot.Method and Results1.Application of scalp nerve block in ROSA Navigated Intracranial Electrode ImplantationMethods 60 patients were randomly divided into two groups:SNB group and TIVA group.In SNB group,0.375%ropivacaine was used to block supratrochlear nerve,supraorbital nerve,zygomatic temporal nerve,Auriculotemporal nerve,greater occipital nerve and lesser occipital nerve respectively after induction of general anesthesia;There was no scalp nerve block in TIVA group.The BIS value was monitored during the operation,the target controlled infusion?TCI?concentration of propofol was adjusted according to the BIS value,and the BIS value was maintained between 45 and 55.During the operation,the TCI concentration of remifentanil was adjusted in real time,and the fluctuation range of HR,SBP and DBP was maintained within±20%of the preoperative level.HR,SBP,DBP and the target concentrations of remifentanil were recorded before anesthesia induction?T₀?,after anesthesia induction?T₁?,When placing the headframe?T₂?,15 minutes after the placing of headstock?T₃?,when the first electrode was implanted?T₄?,when the fifth electrode was implanted?T₅?,15 minutes after all the electrode implantation?T₆?.The total amount of propofol and remifentanil during operation and the time of PCIA analgesia pump after operation were counted.Results There was significant difference in the HR,SBP,DBP and the target concentration of remifentanil between the two groups in T₀?T₆,compared with T₁,T₂,T₄ and T₅ HR,SBP,DBP and remifentanil plasma target concentration values increased significantly?P<0.05?;Compared with T₂,HR,SBP,DBP and the plasma target concentration of remifentanil decreased significantly in T₃?P<0.05?;Compared with T4,T5,HR,SBP,DBP and the plasma target concentration of remifentanil decreased significantly in T6?P<0.05?.In SNB group,there was no significant difference in T₁?T₆ HR,SBP,DBP and remifentanil plasma target concentration?P>0.05?;The total amount of remifentanil in SNB group was significantly less than that in TIVA group?P<0.05?.The PCIA analgesia pump time in TIVA group was shorter than SNB group?P<0.05?.T1?T6,the changes of HR,SBP,DBP and remifentanil plasma target concentration in SNB group were more stable than that in TIVA group.2.Application of Auriculotemporal Nerve block in analgesia after ROSA Navigated Intracranial Electrode ImplantationMethods 60 patients with the application of ROSA robot assisted intracranial electrode implantation were randomly divided into the ANB Group?n=30?and PCIA Group?n=30?.In the ANB group,bilateral auriculotemporal nerves were blocked with0.5%ropivacaine 2-3 mL under the guidance of ultrasound,After the operation,2 mL0.5%ropivacaine was injected thro?gh the indwelling catheter every 8 h to maintain the nerve block effect.PCIA group was given an analgesic pump?2?g/kg sufentanil+2?g/kg dexmedetomidine+ondansetron 8 mg+0.9%physiological saline 100 mL?.Simplified McGill pain scores,adverse reactions?nausea and vomiting,itching,respiratory depression,hypotension,bradycardia,local anesthetic poisoning?were recorded at 4,12,24 and 48 hours after operation.Results There was no significant difference in Mc Gill pain scores between ANB group and PCIA group in 4 h,12 h,24 h and 48 h after operation?P>0.05?.the incidence of adverse reactions and mouth occlusion pain within 12 h in ANB group was lower than that in PCIA group.ConclusionThe results of this study s?ggest that the pain stimulation in the operation of intracranial electrode implantation assisted by Rosa robot mainly comes from the operation of placing the head rest and electrode implantation,which has the characteristics of"pulse type".Pain stimulation mainly occurs during surgical operation,after the head rest is placed and the electrode is implanted,the pain stimulation will be obviously weakened.Scalp nerve block can significantly reduce the pain stimulation during the implantation of intracranial electrode assisted by Rosa,reduce the dosage of narcotic analgesics,and make the hemodynamics of patients more stable.In the implantation of intracranial electrode assisted by ROSA,scalp nerve block combined with intravenous anesthesia is better than total intravenous anesthesia.The selective auriculotemporal nerve block guided by ultrasound as a postoperative analgesia method of intracranial electrode implantation assisted by Rosa robot is equivalent to the traditional patient-controlled intravenous analgesia.Under the guidance of ultrasound,the selective auriculotemporal nerve block can reduce the incidence of postoperative pain of the patients,and reduce the complications related to postoperative analgesia,such as nausea,vomiting,pruritus and so on.Therefore,it has more advantages than patient-controlled intravenous analgesia,and is an effective postoperative analgesia method of intracranial electrode implantation assisted by Rosa robot.To sum up,scalp nerve block and selective auriculotemporal nerve block have high application value in intraoperative and postoperative analgesia respectively,and the effect is safe and reliable,which can be used as an important part of the anesthesia scheme for ROSA robot assisted intracranial electrode implantation for clinical choice.