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. 2019 Nov 21;2019(11):CD011931. doi: 10.1002/14651858.CD011931.pub2

Can 2017.

Methods Study design: randomized, placebo controlled study (3 arms)
Study duration: March 2008 to April 2009
Study setting: hospital, single centre, Turkey
Participants Adults undergoing elective craniotomy (n = 90)
Inclusion criteria

  1. ASA II and ASA II participants undergoing elective craniotomy


Exclusion criteria

  1. Arrhythmia

  2. Uncontrolled hypertension

  3. Diabetes

  4. Coronary artery disease

  5. Coagulopathy

  6. Local anaesthetic allergy


Mean age, range (years)

  1. 48 (18 to 85)


Numbers allocated to each arm

  1. Group B (n = 30)

  2. Group L (n = 30)

  3. Group C (n = 30)


Male gender

  1. Group B = 11/30

  2. Group L = 11/30

  3. Group C = 15/30
Interventions Technique and timing
Scalp block of the following nerves:

  1. Supraorbital and supratrochlear

  2. Zygomaticotemporal

  3. Auriculotemporal

  4. Postauricular branches of the greater auricular

  5. Greater, lesser, and third occipital nerves


5 minutes prior to pinning, using either 20 mL of 0.5% bupivacaine, 20 mL of 0.5% levo‐bupivacaine or saline
Outcomes Primary

  1. Mean arterial blood pressure


Secondary

  1. Heart rate

  2. Pain as measured by the VAS in the first 24 hours after surgery

  3. Additional drug requirement intraoperatively

  4. Numbers of participants requiring additional analgesia in the first 24 hours postoperatively
Notes  
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Quote 'The patients were randomly divided into three groups using a sealed‐enveloped technique'' The authors describe allocation concealment but do not provide details regarding how random allocation was ensured
Allocation concealment (selection bias) Low risk Sealed envelope
Blinding of participants and personnel (performance bias) 
 All outcomes Low risk Block solutions were prepared and numbered by a blinded assistant.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Those assessing outcomes were unaware of the treatment allocations.
Incomplete outcome data (attrition bias) 
 All outcomes Low risk There were no losses to follow‐up.
Selective reporting (reporting bias) Low risk Outcomes were reported as specified.
Other bias High risk Long time between study conduct and publication and small study