Attenuation of the haemodynamic response to placement of the Mayfield skull pin head holder: alfentanil versus scalp block

ObjectiveThis study was performed to determine the effects of scalp blocks with bupivacaine versus levobupivacaine on the haemodynamic response during craniotomy and the efficacies and analgesic requirements of these drugs postoperatively.MethodsThis randomized, prospective, placebo-controlled, double-blind study included 90 patients (age, 18–85 years; American Society of Anesthesiologists physical status, I or II). The patients were randomly divided into three groups: those who received 20 mL of 0.5% bupivacaine (Group B, n = 30), 20 mL of 0.5% levobupivacaine (Group L, n = 30), or saline as a placebo (Group C, n = 30). Scalp blocks were performed 5 min before head pinning. The primary outcome was the mean arterial pressure (MAP), and the secondary outcomes were the heart rate (HR), visual analogue scale (VAS) scores, and additional intraoperative and postoperative drug use. Postoperative pain was evaluated using a 10-cm VAS.ResultsDuring head pinning and incision, the MAP and HR were significantly higher in Group C. The additional drug requirement for intraoperative hypertension and tachycardia was significantly higher in Group C. There were no significant differences in MAP, HR, or VAS scores between Groups B and L.ConclusionBoth bupivacaine and levobupivacaine can be effectively and safely used for scalp blocks to control haemodynamic responses and postoperative pain.

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“…9 , 10 The scalp block is an easy and effective method of blunting the blood pressure response and decreasing morbidity after craniotomy. 11 …”

Section: Discussionmentioning

confidence: 99%

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial

Can

Bilgin

2017

J Int Med Res

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“…17 These hemodynamic fluctuations are equally undesirable in those with coronary heart disease in whom the myocardium is vulnerable to hemodynamic stress response and may precipitate myocardial ischemia and pulmonary edema. 18 Scalp block is quite effective in attenuating the hemodynamic 10,19 and sympathoadrenal response 20 to skull pin insertion and in providing postoperative analgesia. 21 Ropivacaine is a long-acting amide local anesthetic agent with a low potential for cardiotoxicity and central nervous system toxicity due to its reduced lipophilicity as compared with bupivacaine, 22 making it an ideal drug for nerve blocks requiring large volumes and in areas such as the scalp, which are highly vascularized.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial

Singh

Ganesamoorthi²,

Lionel

et al. 2020

J Neuroanaesth Crit Care

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Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application. Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events. Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p < 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events. Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.

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“…Many methods and drugs have been used for attenuation of these hemodynamic changes. Drugs such as beta blockers,[ 16 ] opioids,[ 11 12 13 19 ] local anesthetics,[ 8 ] and alpha agonists[ 14 15 ] have been shown to be effective. Some methods can cause hypotension and possibly lead to cerebral ischemia.…”

Section: Discussionmentioning

confidence: 99%

“…Different methods have been employed to blunt this hemodynamic response. They include: Local anesthetic infiltration of the pin sites on the scalp,[ 8 ] scalp block with local anesthetic,[ 9 ] deepening the plane of anesthesia,[ 10 ] opioids,[ 11 12 13 ] alpha agonists,[ 14 15 ] beta blockers,[ 16 ] and gamma-aminobutyric acid agonists. [ 17 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of intravenous labetalol and bupivacaine scalp block on the hemodynamic and entropy changes following skull pin application: A randomized, open label clinical trial

et al. 2016

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Background:The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes.Patients and Methods:Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min.Results:The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P < 0.05). No adverse effects were noted.Conclusion:Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.

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Attenuation of the haemodynamic response to placement of the Mayfield skull pin head holder: alfentanil versus scalp block

Cited by 7 publications

References 12 publications

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial

Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial

Comparison of intravenous labetalol and bupivacaine scalp block on the hemodynamic and entropy changes following skull pin application: A randomized, open label clinical trial

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