Effect of Scalp Infiltration with Bupivacaine on Early Hemodynamic Responses during Craniotomy under General Anesthesia

Abstract

The present study was conducted to evaluate the effect of scalp infiltration with Bupivacaine on hemodynamic responses during early stimulation in craniotomy under general anesthesia. Thirty six patients were prospectively randomized to receive Bupivacaine scalp infiltration (B group) or a saline control (S group) as an adjuvant to general anesthesia using isoflurane in 50% N2O-O2. Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded as base line, after scalp incision or pin insertion and then every 3 min until 12 min. The measurements were repeated every 5 min till dura was opened. The mean difference between the two groups for HR during scalp incision or pin insertion was significant (p = 0.03). The mean MAP throughout the time intervals of preincision or pin insertion to 12 min postincision and then to dural opening were statistically different between the two groups (p = 0.001). No complications related to the technique of block or drugs were recorded. Scalp infiltration with Bupivacaine as an adjuvant to general anesthesia can provide more stable hemodynamics, as measured by HR and MAP changes during early stimulation in craniotomy.

A Comparison Between Scalp Nerve Block and Local Anesthetic Infiltration on the Inflammatory Response, Hemodynamic Response, and Postoperative Pain in Patients undergoing Craniotomy for Cerebral Aneurysms: A Randomized Controlled Trial

“…These results are in line with the study of Geze et al (7), in which scalp nerve block with 0.5% bupivacaine has been shown to be better in blunting the haemodynamic response to strong nociceptive stimulus, such as head pinning, than local infiltration or routine analgesia (7). However, the effects of local infiltration in promoting intraoperative hemodynamic stability in patients undergoing craniotomy have also been reported in the previous studies (26)(27)(28). Our study is inconsistent with these studies.…”

A Comparison Between Scalp Nerve Block and Local Anesthetic Infiltration on the Inflammatory Response, Hemodynamic Response, and Postoperative Pain in Patients undergoing Craniotomy for Cerebral Aneurysms: A Randomized Controlled Trial

“…These results are in line with the study by Geze et al (7), in which scalp nerve block with 0.5% bupivacaine was shown to be better at blunting the hemodynamic response to strong nociceptive stimulus, such as head pinning, than local infiltration or routine analgesia (7). However, the it has also been reported that local infiltration promotes intraoperative hemodynamic stability in patients undergoing craniotomy (26)(27)(28). Our study is inconsistent with these studies.…”

Hemodynamic and Bispectral Changes During Pin Insertion in Craniotomy – Effect of Locally Infiltrated Bupivacaine

“…Likewise, in the study of Mohammadin from 2003 [19] it is found that the biggest significant difference p = 0.03 using bupivacaine 0.25% is achieved through the heart rate changes. The study of Bloomfield from 1998 [15] reported a lacking hemodynamic response as result of the skin incision with 0.5% bupivacaine adding adrenaline as adjunct.…”