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Craniotomy SurgeryNCT07886034

Sphenopalatine Ganglion Block Combined With Either Scalp Nerve Block or Local Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Craniotomy: A Randomized Controlled Trial

A study testing Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block and Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration in people with Craniotomy Surgery, run by Zagazig University.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Official record
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Trial summary

The use of multimodal regional analgesia (scalp block, local scalp infiltration, and sphenopalatine ganglion block) for postoperative pain management after craniotomy Read more about this study

Who is it for?
Ages 21 to 60 years
Conditions the study is for
Craniotomy Surgery
What is being tested?
Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block and Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration
Could I receive a placebo?
No, everyone receives an active treatment
How many people
54 participants
Where
No sites listed yet
Study dates
30 Oct 2026to 24 Apr 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Patient acceptance
  • Patients age between 21-60 years old.
  • Both sexes.
  • ASA Physical status II - III.
  • BMI ≥ 18 kg/m2 \& ≤ 35 kg/m2.
  • Elective craniotomy for supratentorial tumor under general anesthesia.
  • Glasgow Coma Scale (GCS) =15.
  • Ability of the patient to understand pain assessment score

Who cannot join

  • Uncooperative patients.
  • Allergy to study local anesthetics.
  • patients on antiplatelet, anticoagulant or B blocker
  • Pregnancy or lactation.
  • Previous surgery affected nasal anatomy.
  • Severe hepatic or renal impairment.
  • Chronic opioid therapy.
  • Previous craniotomy.

About this study

Official title: Sphenopalatine Ganglion Block Combined With Either Scalp Nerve Block or Local Wound Infiltration for PostoperativeZagazig Analgesia in Adult Patients Undergoing Craniotomy: A Randomized Controlled Trial

The use of multimodal regional analgesia (scalp block, local scalp infiltration, and sphenopalatine ganglion block) for postoperative pain management after craniotomy

Read the detailed description

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.

Being tested
Group (c): control group patients will receive general anesthesia., Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block, Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Group (c): control group patients will receive general anesthesia.Other

    control group patients will receive general anesthesia.

  • Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve BlockProcedure or surgery

    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
  • Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltrationProcedure or surgery

    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

Study groups in NCT07886034
Study groupRoleWhat they receive
Group (c): control groupOthercontrol group patients will receive general anesthesia
Receives: Other: Group (c): control group patients will receive general anesthesia.
Group (SS): patients will receive Sphenopalatine Ganglion Block and Scalp Nerve BlockActive comparatorSPGB 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
Receives: Procedure: Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block
Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltrationActive comparatorSPGB 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
Receives: Procedure: Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 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

    Measured: the first time after recovery from anesthesia when visual analog scale more than or equal 3 at first 24 hours postoperative

Secondary outcomes (3)
  1. 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.

    Measured: at 0 minutes and 1,2,4,6,8 ,12,18,24 hours postoperative.

  2. 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

    Measured: 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

  3. Total Dose of rescue analgesia (nalbuphine) mg

    Total Dose of rescue analgesia (nalbuphine) by mg used in the first 24 hours will be recorded.

    Measured: in the first 24 hours will be recorded.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Oct 2026
  2. Study start30 Oct 2026 (estimated)
  3. Primary completion24 Mar 2027 (estimated)
  4. Study completion24 Apr 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
* Group (c): the control group patient will receive general anesthesia. * Group (SS): patients will receive SPGB with SNB 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 for each nostril. The applicator stays in place for about 5-10 minutes for each nostril. * Group (SL): patients will receive SPGB with local wound infiltration
Masking
Double blind
Who is masked
Participant, Investigator
Enrolment
54 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07886034
Sponsor's protocol ID
ZAGAZIG/ANESTHESIA-2026
Status last verified
Oct 2026
First submitted
28 Aug 2026
Last updated
21 Oct 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes

Publications

  • Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int. 1985;5(4):145-8. doi: 10.1007/BF00541514.

    PubMed 4048757
  • Pini A, Sarafis P, Malliarou M, Tsounis A, Igoumenidis M, Bamidis P, Niakas D. Assessment of patient satisfaction of the quality of health care provided by outpatient services of an oncology hospital. Glob J Health Sci. 2014 Jun 12;6(5):196-203. doi: 10.5539/gjhs.v6n5p196.

    PubMed 25169006
  • Gitman M, Fettiplace MR, Weinberg GL, Neal JM, Barrington MJ. Local Anesthetic Systemic Toxicity: A Narrative Literature Review and Clinical Update on Prevention, Diagnosis, and Management. Plast Reconstr Surg. 2019 Sep;144(3):783-795. doi: 10.1097/PRS.0000000000005989.

    PubMed 31461049
  • Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974 Jun 22;2(5920):656-9. doi: 10.1136/bmj.2.5920.656.

    PubMed 4835444
  • Nguyen A, Girard F, Boudreault D, Fugere F, Ruel M, Moumdjian R, Bouthilier A, Caron JL, Bojanowski MW, Girard DC. Scalp nerve blocks decrease the severity of pain after craniotomy. Anesth Analg. 2001 Nov;93(5):1272-6. doi: 10.1097/00000539-200111000-00048.

    PubMed 11682413
  • Pinosky ML, Fishman RL, Reeves ST, Harvey SC, Patel S, Palesch Y, Dorman BH. The effect of bupivacaine skull block on the hemodynamic response to craniotomy. Anesth Analg. 1996 Dec;83(6):1256-61. doi: 10.1097/00000539-199612000-00022.

    PubMed 8942596
  • Piagkou M, Demesticha T, Troupis T, Vlasis K, Skandalakis P, Makri A, Mazarakis A, Lappas D, Piagkos G, Johnson EO. The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice. Pain Pract. 2012 Jun;12(5):399-412. doi: 10.1111/j.1533-2500.2011.00507.x. Epub 2011 Sep 29.

    PubMed 21956040
  • Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain. 1986 Oct;27(1):117-126. doi: 10.1016/0304-3959(86)90228-9.

    PubMed 3785962
  • 6. Gupta R, Bogra J, Kothari N. Effect of local anesthetic wound infiltration on postoperative pain and opioid consumption after craniotomy. Journal of Neurosurgical Anesthesiology. (2018);30(2):140-146.

  • 5. Kassem AA, Youssef A, Ahmed N, Mohammed M, Gamal A. Scalp block versus subcutaneous infiltration for stereotactic procedures: randomized comparison. Research and Opinion in Anesthesia & Intensive Care. (2019);6(1):134139. doi: 10.4103/roaic.roaic_24_18.

  • Yang X, Ma J, Li K, Chen L, Dong R, Lu Y, Zhang Z, Peng M. A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. BMC Anesthesiol. 2019 Jun 1;19(1):91. doi: 10.1186/s12871-019-0760-4.

    PubMed 31153358
  • Mantovani G, Sgarbanti L, Indaimo A, Cavallo MA, De Bonis P, Flacco ME, Scerrati A. Effects of a sphenopalatine ganglion block on postcraniotomy pain management: a randomized, double-blind, clinical trial. Neurosurg Focus. 2023 Dec;55(6):E13. doi: 10.3171/2023.9.FOCUS23549.

    PubMed 38262005
  • 2. Kianian, S., Bansal, J., Lee, C. Perioperative multimodal analgesia: a review of efficacy and safety of the treatment options. APS 2, 9 (2024). https://doi.org/10.1007/s44254-023-00043-.

  • 1. Samagh N, Jangra K, Dey A. Postcraniotomy pain: An update. Journal of Neuroanaesthesiology and Critical Care. (2023); 10(1): 21-30.

Questions about this trial

What is this clinical trial studying?

A study testing Group (SS): Sphenopalatine Ganglion Block with either Scalp Nerve Block and Group (SL): patients will receive Sphenopalatine Ganglion Block with local wound infiltration in people with Craniotomy Surgery, run by Zagazig University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 21 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The time interval from patient recovery to the first use of rescue analgesia (nalbuphine) (time frame: the first time after recovery from anesthesia when visual analog scale more than or equal 3 at first 24 hours postoperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07886034, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Oct 2026.

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