Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy

Chaki, Tomohiro; Sugino, Shigekazu; Janicki, Piotr K.; Ishioka, Yoshiya; Hatakeyama, Yosuke; Hayase, Tomo; Kaneuchi-Yamashita, Miki; Kohri, Naonori; Yamakage, Michiaki

doi:10.1097/ana.0000000000000149

Cited by 47 publications

(41 citation statements)

References 22 publications

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“…In the current study, there were no intraoperative increase in blood pressure or heart rate which comes in agreement with the results obtained by previous studies that stated that during surgery, local anesthesia reduces the hemodynamic responses occurring during the application of Mayfield clamp [5,36]and during closure of the dura and the skin [37]. The brain tissue itself lacks sensory innervation, thereby, these times of surgery are much more painful than tumor resection [38].…”

Section: Discussionsupporting

confidence: 92%

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Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

Nasr

Waly

Morsy

2020

Egyptian Journal of Anaesthesia

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Methodology: Forty patients were randomly allocated into 4 equal groups based on LA mixture used for scalp block: Group I:received 1.5 mg/kg bupivacaine 0.25% + 5 mg/kg lidocaine 1% with 1:200,000 epinephrine. Group II:same as Group I + 8 mg dexamethasone. Group III:same as Group I + 500 mgMgSO 4. Group IV:same as Group I + 8 mgdexamethasone + 500 mgMgSO 4. Dexmedetomidine was used for intraoperative sedation and paracetamol for postoperative analgesia. Results: Total intra-operative consumption of dexmedetomidine was highly significantly less in Group II (232 ± 21 µg) and Group III (241 ± 18 µg) compared to Group I (286 ± 27 µg). Group IV (162 ± 25 µg) was highly significantly less than other groups. Time to first paracetamol requirement was highly significantly longer in Group II (245 ± 32 min) and Group III (236 ± 28 min) compared to Group I (187 ± 17 min). Group IV (388 ± 14 min) showed a highly significant longer time than other groups. Group IV consumed highly significant less doses of paracetamol in the first postoperative day (POD1) (2.2 ± 0.1 g) than Group I (2.9 ± 0.4 g), Group II (2.7 ± 0.3 g) and Group III (2.8 ± 0.5 g).Pain in POD1 was significantly higher in Group I at after 3 h of surgery compared to other groups. VAS was comparable during the rest of the times of the study among the four groups. All patients were hemodynamically stable during times of the study. Blood glucose levels were within normal levels with no significant differences between the groups within 6 hof scalp block. Conclusion: Adding either 8 mg©dexamethasone or 500 mg©MgSO4 or both to bupivacainelidocaine for scalp block before awake craniotomy improves performance of the block with the best results when combined.

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Section: Discussionsupporting

confidence: 92%

“…It only requires analgesia and special attention to non-pharmacological interventions such as hypnosis [4]. Local anesthesia is the cornerstone in awake craniotomy surgeries [5][6][7]. In awake allthrough technique, effective local anesthetics is mandatory [3].…”

Section: Introductionmentioning

confidence: 99%

Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

Nasr

Waly

Morsy

2020

Egyptian Journal of Anaesthesia

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“…The rate of intra-procedure hypoxemia in our study was 2.9% and is in line with published data on propofol used for sedation purposes, and if managed appropriately, has not been shown to result in adverse outcomes [22,23]. We did not measure the serum levels of ropivacaine and lignocaine in our patients, but limiting the dose to that used in the paracervical block mixture appears safe and comparable to published results on safety [24]. Postoperative nausea and vomiting that have been reported with the use of intravenous fentanyl were not seen in our study, likely due to the low doses used and the known antiemetic efficacy of ondansetron in the postoperative setting [25,26].…”

Section: Discussionsupporting

confidence: 90%

Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting

Leong

Tan

Choo

et al. 2017

jcb

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PurposeTo determine the feasibility and safety of outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia.Material and methodsWe included patients diagnosed with non-metastatic cervix cancer and have completed brachytherapy between December 2015 and December 2016. Moderate to deep sedation was achieved using intravenous midazolam, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline. Ceftriaxone and ondansetron were given prophylactically. Physiologic monitoring was performed throughout and pain scores were recorded using the Numeric Rating Scale. Follow-up was conducted at 8 weeks from the last fraction of brachytherapy. The feasibility and safety endpoints were a post-anesthesia discharge score (PADS) of 9 or above, and no grade 3 or above adverse events, respectively.ResultsA total of thirty-five brachytherapy insertions were carried out on nine patients. The median age of the patients was 56 years (range, 40-65). Eight patients had American Society of Anesthesiologists’ physical status of I or II, and one had a status of III. The mean duration of the insertion was 39 minutes (standard deviation [SD] = 14), during which no adverse events occurred. There was no significant nausea or vomiting post-sedation. The median pain scores post-insertion and during recovery were 0 (range, 0-6) and 0 (range, 0-7), respectively. At discharge, all patients had pain scores of 0 and maximum PADS of 10. The mean time to discharge was 4.1 hours (SD = 0.95). There were no brachytherapy-related admissions or complications.ConclusionsOutpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia is feasible and safe. This could potentially lead to significant cost savings.

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“…Currently, MAC is the most popular anesthetic technique used during the post-awake phase *40-60 mL of 0.25% bupivacaine mixed with 1% lidocaine [50:50] and 1:100,000 epinephrine). 6,55,56 Field infiltration and scalp nerve block are distinct approaches. Some institutions rely solely on field infiltration, whereas others combine field infiltration (primary modality) with scalp nerve blocks as adjuncts.…”

Section: Local Anesthesia For Analgesiamentioning

confidence: 99%

Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner

Meng

McDonagh

Berger

et al. 2017

Can J Anesth/J Can Anesth

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Awake craniotomy (AC), defined as the performance of at least part of an open cranial procedure with the patient awake, has been tied to beneficial outcomes compared with similar surgery under general anesthesia. Improved anesthetic techniques have made a major contribution to the increasing popularity of AC. However, the heterogeneity of practice among institutions doing large numbers of ACs raises questions (often among those who only occasionally perform AC - i.e., practitioners in low-volume AC institutions) as to the ideal anesthetic technique for AC. The procedure presents a variety of decision-making dilemmas, the origins of which are the varying institutional preferences, lack of quality evidence, and several practice controversies. Evidence-based data that support a single anesthetic algorithm for AC are sparse. In this narrative review, the technical nuances of 13 aspects of anesthetic care for AC are discussed based on institutional preferences and available evidence, and the various controversies and research priorities are discussed. The skills, experience, and commitment of both the surgeon and the anesthesiologist are large variables that are likely more important than what the literature suggests about "best" techniques for AC. Optimizing patient outcome is the fundamental goal of the anesthesiologist.

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Efficacy and Safety of a Lidocaine and Ropivacaine Mixture for Scalp Nerve Block and Local Infiltration Anesthesia in Patients Undergoing Awake Craniotomy

Abstract: Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

Cited by 47 publications

References 22 publications

Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants

Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting

Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner

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