A prospective, comparative, randomised, double blind study on the efficacy of addition of clonidine to 0.25% bupivacaine in scalp block for supratentorial craniotomies

Abstract

Background and Aims:Scalp blocks combined with general anaesthesia reduce pin and incision response, along with providing stable perioperative haemodynamics and analgesia. Clonidine has proved to be a valuable additive in infiltrative blocks. We studied the efficacy and safety of addition of clonidine 2 μg/kg to scalp block with 0.25% bupivacaine (Group B) versus plain 0.25% bupivacaine (Group A) for supratentorial craniotomies.Methods:Sixty patients were randomly divided into two groups to receive scalp block: Group A (with 0.25% bupivacaine) and Group B (with 0.25% bupivacaine and clonidine (2 μg/kg). Bilateral scalp block was given immediately after induction. All the patients received propofol based general anaesthesia. Intraoperatively, propofol infusion was maintained at 75 to 100 μg/kg/h up to dura closure and reduced to 50-75 μg/kg/h up to skin closure with atracurium infusion stopped at dura closure. Heart rate (HR) and mean arterial pressure (MAP) were monitored at pin insertion, at 5 minute intervals from incision till dura opening and again at 5 minute interval from dura closure up to skin closure. Fentanyl 0.5 μg/kg was given if a 20% increase in either HR and/or MAP was observed. Postoperative haemodynamics and verbal rating scores (VRS) were recorded. When the VRS score increased above 3, rescue analgesia was given. Any intraoperative haemodynamic complications were noted.Results:Group A showed a significant increase in haemodynamic variables during the perioperative period as compared to group B (P < 0.05). Addition of clonidine 2 μg/kg in the infiltrative block also provided significantly prolonged postoperative analgesia.Conclusions:Addition of clonidine to scalp block provided better perioperative haemodynamic stability and significantly prolonged analgesia.

Effect of intra-articular alpha-agonists on post-operative outcomes following arthroscopic knee surgery: A systematic review and meta-analysis

“…The analgesic efficacy of IALA with morphine, for example, has been demonstrated, but side effects are a concern [5,6]. There is now growing evidence to support the use of the alpha-2 agonists, clonidine and dexmedetomidine, as useful adjuncts to LA in orthopaedics and neurosurgery [7][8][9][10][11].…”

Perbedaan Respon Hemodinamik terhadap Penambahan Clonidin 1 dan 2 mcg/kgbb pada Scalp Block untuk Operasi Kraniotomi

“…8 Telah banyak diteliti penambahan klonidin pada blok scalp salah satunya mendapatkan bahwa penambahan klonidin ke blok scalp memberikan onset dini blok dengan stabilitas hemodinamik perioperatif yang lebih baik serta penggunaan opioid intraoperatif dapat berkurang dengan durasi analgesia yang memanjang. 9 Begitu pula penelitian lain mendapatkan bahwa penambahan klonidin pada blok scalp menyebabkan penurunan laju nadi yang signifikan dengan aplikasi pin sebanding dengan pemberian klonidin secara intravena. Parameter hemodinamik seperti systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) dan rate pressure product (RPP) diturunkan secara signifikan dengan penambahan klonidin ke blok scalp serta lewat intravena.…”

Perbandingan Antara Fentanil 2 μg/kgBB/jam dan Scalp Block Terhadap Peningkatan Hemodinamik dan Kadar Glukosa Darah Sewaktu Saat Pemasangan Pin Kepala Pada Kraniotomi

“…Teknik ini merupakan alternatif penggunaan opioid dosis tinggi dalam menurunkan angka kejadian hipertensi, takikardia, serta stres neuroendokrin. [6][7] Sekresi hormon adrenokortikotropik (ACTH) akibat stimulasi respons stres operasi bermanifestasi terhadap peningkatan sekresi katekolamin dan kortisol oleh glandula adrenal. Stimulasi kedua hormon tersebut mengganggu kerja insulin dan meningkatkan glikogenolisis sehingga terjadi peningkatan kadar glukosa darah.…”

“…4 Solusi mengatasi nyeri pada prosedur kraniotomi selain penggunaan opiod adalah menggunakan teknik scalp block dikombinasikan dengan anestesi umum. 5,6 Penelitian ini dilakukan pada dua kelompok yaitu fentanil 2 μg/kgBB/ jam dan scalp block dengan bupivakain 0,25%.…”