Influence of scalp nerve block on analgesia and hemodynamic stability in pediatric patients: a systematic literature review and meta-analysis.

Abstract

Among current procedures for analgesia and control of hemodynamic changes, scalp nerve block (SNB) stands out as a simple technique that contributes to the quality of patient recovery. This study aims to evaluate the influence of SNB on postoperative pain and hemodynamic stability in pediatric patients. A review protocol was registered on PROSPERO under the registry code CRD42023491890. The search string "nerve block AND scalp AND analgesia" was used to search MEDLINE-PubMed, Embase, Cochrane, LILACS, SciELO, and Scopus. R software was used for meta-analysis, and I²was used to assess heterogeneity. A total of 314 trials were identified. Out of these, 310 articles were excluded after title, abstract, and full-text reading. Four randomized trials (n = 186 pediatric patients undergoing head surgery) were included in the review. All studies performed SNB to five scalp nerves with ropivacaine or bupivacaine. The SNB was performed plus ropivacaine concentrations of 0.20% and 0.30%. Analgesic effects were observed as ropivacaine significantly reduced the Face, Legs, Activity, Cry and Consolability (FLACC) scale compared to the control group at both time points (p < 0.01). The effect on hemodynamic stability was observed only at the 0.30% concentration, immediately after incision (p < 0.01). The results demonstrate that SNB plus ropivacaine reduces postoperative pain in children and decreases mean arterial pressure after incision in pediatric head surgery.