An interventional study of Group (c): control group patients will receive general anesthesia. and Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block in Craniotomy Surgery, sponsored by Zagazig University. Not yet recruiting. Open to participants aged 21 Years to 60 Years. Per ClinicalTrials.gov, last updated 2026-10-21.
Sponsored by Zagazig University · Not applicable, Interventional, and Other
The use of multimodal regional analgesia (scalp block, local scalp infiltration, and sphenopalatine ganglion block) for postoperative pain management after craniotomy
Post-craniotomy pain has often been under-estimated; many patients wake up with moderate to severe pain during the first day after the operation, especially from the skin incision, temporalis muscle handling, and irritation of the periosteum. This pain is usually sharp and localized, and even simple actions like coughing, turning the head, or touching the scalp can make it worse. If this pain is not well controlled, it may raise blood pressure and intracranial pressure, delay neurological assessment, prolong ICU stay, and increase patient stress.
Multimodal regional analgesia is a pain management approach that combines two or more regional anesthesia techniques to target pain from different pathways. Instead of relying solely on systemic medications like opioids, this strategy uses nerve blocks, local infiltration, or other targeted techniques to numb the surgical area, reduce pain signals to the brain, and minimize side effects. The goal is to provide more effective, longer-lasting pain relief while improving patient comfort, reducing anxiety, and supporting faster recovery.
The sphenopalatine ganglion block (SPGB) is a minimally invasive technique performed through the nose, targeting a nerve center involved in cranial pain. Traditionally used for migraines and facial pain, it is now being applied after craniotomy to reduce headache and overall pain. SPGB can lower post-surgery pain, reduce opioid needs, and stabilize blood pressure by affecting central pain.
The scalp nerve block (SNB) is a well-established regional anesthesia technique that targets six paired sensory nerves of the scalp: the supraorbital, supratrochlear, auriculotemporal, zygomaticotemporal, greater occipital, and lesser occipital nerves. By anesthetizing these nerves before incision, SNB significantly reduces nociceptive input from the scalp and periosteum. Clinical studies show that SNB lowers intraoperative hemodynamic surges, decreases opioid requirements, and improves early postoperative pain scores.
Local wound infiltration (LWI) is another commonly used method to manage post-craniotomy pain. The surgeon injects long-acting local anesthetic along the incision line and around the periosteum, directly targeting the area of surgical trauma. It is simple, requires no special equipment, and can be easily done during surgery.
It provides meaningful early postoperative analgesia and reduces the need for strong pain medications. LWI is practical and effective, especially when time or resources limit the use of a fu1ll scalp block.
Zagazig University is the lead sponsor of 457 studies on the registry; 77 are open to participants now.
Of its 5 completed or terminated interventional studies of FDA-regulated products, 0 (0%) have results posted.
Counted across the registry records on this site, refreshed daily.
Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
control group patients will receive general anesthesia
Other: Group (c): control group patients will receive general anesthesia.
SPGB will be done as follows (gently place a soft cotton applicator inside the patient's nostril; the cotton is long and thin, like a medical swab, and soaked with 1-2 ml lidocaine 2%for each nostril. The applicator stays in place for about 5-10 minutes for each nostril (8). Then scalp nerve block will be done while the patient is in a supine position. Clean the skin with povidone-iodine. Use a 25G needle for injection of a cocktail of 3mg/kg lidocaine 2%,1mg/kg 0.5% bupivacaine, and 4 mg dexamethasone diluted in 32 ml NS 0.9% to be injected on both sides 16 ml on each side to cover the following nerves (9). 1. Supraorbital Nerve Block 2. Supratrochlear nerve block 3. Zygomaticotemporal nerve block 4. Auriculotemporal nerve block
Procedure: Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block
SPGB will be done as in group CS, at the end of surgery, local wound infiltration will be done by the surgeon who will inject 3 mg/kg lidocaine 2%,1mg/kg 0.5% bupivacaine, and 4 mg dexamethasone diluted in 32 ml NS 0.9% around the line of surgery
Procedure: Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration
control group patients will receive general anesthesia.
SPGB will be done as follows (gently place a soft cotton applicator inside the patient's nostril; the cotton is long and thin, like a medical swab, and soaked with 1-2 ml lidocaine 2%for each nostril. The applicator stays in place for about 5-10 minutes for each nostril Then scalp nerve block will be done while the patient is in a supine position. Clean the skin with povidone-iodine. Use a 25G needle for injection of a cocktail of 3mg/kg lidocaine 2%,1mg/kg 0.5% bupivacaine, and 4 mg dexamethasone diluted in 32 ml NS 0.9% to be injected on both sides 16 ml on each side to cover the following nerves 1. Supraorbital Nerve Block 2. Supratrochlear nerve block 3. Zygomaticotemporal nerve block 4. Auriculotemporal nerve block
SPGB will be done as in group CS, at the end of surgery, local wound infiltration will be done by the surgeon who will inject 3 mg/kg lidocaine 2%,1mg/kg 0.5% bupivacaine, and 4 mg dexamethasone diluted in 32 ml NS 0.9% around the line of surgery
The time interval from patient recovery to the first use of rescue analgesia (nalbuphine)
the time interval between recovery from anesthesia and the need for rescue analgesia
Time frame: the first time after recovery from anesthesia when visual analog scale more than or equal 3 at first 24 hours postoperative
post-craniotomy pain
1-Measuring the Intensity of post-craniotomy pain during the first 24 hours after surgery using a validated pain scale as Visual Analog Scale, 0-10, which is a tool used to measure subjective experience of the patient, it consists of 10 cm ranging from zero which equal no pain till 10 which equal severe pain.
Time frame: at 0 minutes and 1,2,4,6,8 ,12,18,24 hours postoperative.
Intraoperative patient (Blood Pressure by mmHg )
Intraoperative vital sign of the patients (Blood Pressure by mmHg) will be recorded at baseline (once patient shifted to operating room) and every 5 minutes in the first 30 minute then every 15minutes until the end of surgery
Time frame: will be recorded at baseline (once patient shifted to operating room) and every 5 minutes in the first 30 minute then every 15minutes until the end of surgery
Total Dose of rescue analgesia (nalbuphine) mg
Total Dose of rescue analgesia (nalbuphine) by mg used in the first 24 hours will be recorded.
Time frame: in the first 24 hours will be recorded.
No study locations are listed for this record.
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes
Supporting information: Study protocol, Statistical analysis plan, Informed consent form
Time frame: planned after the completion of the study publication
Access criteria: principal investigator
Start is estimated for Oct 2026; primary completion for Mar 2027, 4 months later.
How these figures are worked out, and which studies are left out of them.
From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗
This study is not yet recruiting, as verified in Oct 2026. You cannot join it, but the record below documents what was studied.
Get an email when the registry record changes — status, dates, results — or when someone posts here.
Sign in to followQuestions and observations about this study, from anyone following it. Not medical advice, and not a channel to the study team — their contact details are on the registry record.
Sign in to join the discussion. Reading takes no account; posting does. You choose a display name, and a pseudonym is the default.
Nothing here yet. If you are running this trial, taking part in it, or weighing whether to, this is the place to say so.