Influence of Levobupivacaine Regional Scalp Block on Hemodynamic Stability, and Intra- and Postoperative Opioid Consumption in Supratentorial Craniotomies: Increasing Security

In Response

“…To increase the safety of injections, these were achieved using low concentrations of levobupivacaine and strict aseptic rules. Although our sample size is probably too small to draw definitive conclusions about the safety of the technique, our results indicate that, as mentioned by Dr Niño et al, 1 regional scalp block can be performed safely by experienced practitioners without the help of the echo. That said, we are convinced that the echo-guided technique they propose has the potential to refine the performance of these blocks, in an elegant way.…”

“…To the Editor I wish to thank Dr Feldman et al 1 for their excellent article on modern practice in CO 2 absorption. I thoroughly enjoyed it and will recommend it to my students and colleagues.…”

“…We are very grateful to Dr Niño et al 1 for their interest and comments in our article about the influence of levobupivacaine regional scalp block on hemodynamic stability and intrapostoperative pain management in supratentorial craniotomies. 2 The main purpose of our study was to demonstrate that the use of regional scalp block in this instance is beneficial to the patients in terms of intraoperative hemodynamic control and postoperative pain. This is a first step before proposing the technique more largely, but, of note, our results do not mean that the same cannot be achieved with well-balanced multimodal analgesia protocols.…”

“…This is a first step before proposing the technique more largely, but, of note, our results do not mean that the same cannot be achieved with well-balanced multimodal analgesia protocols. In their comment, Dr Niño et al 1 propose to perform regional scalp block more safely and with greater chances of success using ultrasound guidance. This technique was already described by Zetlaoui et al 3 The most recent literature reviews about regional scalp block report complications related to this locoregional technique to be rare and infrequent.…”

Treating Increased Inspired Carbon Dioxide

“…2 He has identified in his letter to the editor both a misleading explanation that warrants correction, and a numerical error. 1 Our primary objective in the part of the article referenced is to encourage the practice of replacing CO 2 absorbent when the inspired CO 2 concentration on the capnogram reaches 5 mm Hg or 0.5%, rather than based on a change in the indicator. Since the unit of measurement of CO 2 concentration is either mm Hg (torr) or percent depending on the practice setting, we provided a recommendation in both units that were intended to be easy to remember.…”