Posterior scalp block with bupivacaine and dexmedetomidine for pain management in posterior fossa surgeries: a prospective, double blind randomized controlled trial.

Background: Pain management in posterior fossa surgeries poses significant challenges, with opioid-based approaches causing unwanted side effects. This study evaluates the efficacy of posterior scalp block using bupivacaine and dexmedetomidine compared to skin infiltration for managing perioperative pain.

Methods: In this prospective, double-blind, randomized controlled trial, 34 adult patients undergoing elective posterior fossa surgeries were equally assigned to either posterior scalp block or skin infiltration groups. Outcomes measured included hemodynamic parameters, pain scores, opioid consumption, time to first analgesic, and sedation levels.

Results: The posterior scalp block group showed significantly lower opioid consumption (211.47 ± 101.95 mcg vs 305.88 ± 117.10 mcg; p < 0.01) and pain scores (VAS 2.29 ± 0.9 vs 5.06 ± 1.3; p < 0.001) at 24 hours post-surgery. This group also demonstrated better hemodynamic stability and fewer rescue opioid requirements (9 vs 15 patients; p < 0.009).

Conclusions: Posterior scalp block with bupivacaine and dexmedetomidine significantly improves pain management, reduces opioid use, and provides better hemodynamic stability compared to skin infiltration in posterior fossa surgeries.

Clinical trial registration: CTRI/2023/07/0554959.