Efficacy of Fentanyl and/or Lidocaine on Total Antioxidants and Total Oxidants During Craniotomy

Abstract

Objective: The aim of this study was to investigate the oxidative, hemodynamic, and analgesic effects of local lidocaine infiltration, or intravenous (IV) fentanyl injection, or a combination of lidocaine and IV fentanyl during head fixation in a 3-pin headrest in patients undergoing elective craniotomy.Design: Double-blind, randomized, placebo-controlled study. Setting: Gaziantep University Medical Faculty, Department of Anesthesiology and Reanimation.Methods: Eighty patients were randomly assigned to one of four groups. Five minutes before pin fixation, patients in group L received 1 mg/kg of lidocaine 2% for scalp infiltration (n=20), group F received 1 µg/kg of IV fentanyl (n=20), group FL received 1 mg/kg of lidocaine 2% and 1 µg/kg of fentanyl (n=20), and group P received a placebo (n=20). Following standard anesthesia, basal, pre-and post-fixational hemodynamic data were recorded. Blood samples were taken for evaluation of oxidant and antioxidant levels before and after pin fixation. Results:The total antioxidant levels after pin fixation were highest in group FL followed by group F, then group L and finally group P (ie, FL>F>L>P) (P<0.05). The mean arterial blood pressure (MAP) after pin fixation was higher than the MAP before pin fixation in groups L and P (P<0.05), but was lower in groups F and FL (P<0.05). Conclusion:The combination of fentanyl and lidocaine before pin fixation is useful in preventing severe hemodynamic response to pain stimuli, such as pin fixation, and in increasing total antioxidant levels in the post-fixational period during craniotomy in adults.

Biochemical analysis and comparative studies on Diospyros kaki extracts

“…The unripe fruit extract could be helpful for tissues growth and regulate body functioning as lower value of total oxidant status has been reported more potent in many biochemical processes (Mizrak et al 2011). Similarly, resulted less amount of TOS in this work could reinforce the antioxidant capacity in unripe fruit for carotenoids,lycopene and other biochemical activities.…”

A Comparative Study of Intravenous Dexmedetomidine with Local Infiltration of Ropivacaine in Attenuation of Stress Response to Skull Pin Insertion in Craniotomies

“…Skull pin insertion elicits pain due to stimulation of scalp and periosteal nerve endings that induces not only hemodynamic response but also an increase in stress hormones. [1][2][3] Various methods have been employed to abate these responses such as deepening the plane of anesthesia, opioids like fentanyl, alfentanil, and remifentanil, β-blockers, gabapentin, α-agonists (clonidine and dexmedetomidine), scalp blockade, and local anesthetic infiltration at pin insertion sites. 4 Local infiltration with ropivacaine provides sufficient analgesia and hemodynamic stability at the time of pin insertion.…”

“…Skull pin insertion elicits pain due to stimulation of scalp and periosteal nerve endings that induces not only hemodynamic response but also an increase in stress hormones. 1 2 3…”

Comparison of effect of Labetalol and fentanyl with only fentanyl for attenuating pressure responses to intubation and skull pin insertion in neurosurgery

“…7,8 But narcotics alone are not sufficient to prevent a haemodynamic response to skull pin insertion. 9 So there is a need to combine other drug with fentanyl.…”