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

Abstract

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.

Awake Craniotomy in Africa: A Scoping Review of Literature and Proposed Solutions to Tackle Challenges

“…Sixteen studies (84.2%) provided information on operation time. [22][23][24][25][26][27][28][30][31][32][34][35][36][37]39,40 The longest mean operation time was more than 237 minutes, 24 whereas the shortest operation time was 1 hour 33 (Supplementary Table 3, http://links.lww.com/NEU/D712).…”

“…Eighteen studies (94.7%) reported the primary analgesic and sedation used in AC. 22-34,36-40 Propofol/fentanyl combination was used for sedation/analgesia in 10 studies (52.6%) 22,24,26-31,36,37 ( Supplementary Table 3, http://links.lww.com/NEU/D712).…”

Predictors of stimulation-induced seizures during perirolandic glioma resection using intraoperative mapping techniques

“…The local anesthetic was bupivacaine-lidocaine mixture with adjuvants as Mg sulfate and dexamethasone as previously reported by our team. [ 28 ] Usually 3-5 ml is enough for each nerve. A field block was then applied in the region of the incision.…”

Awake craniotomy: nuts and bolts

“…TCI technology is recommended because it is safe and can provide better drug titration and better cardiorespiratory stability 17 . The combination of propofol and remifentanil is the most reported choice, with a ∼9-minute time of emergence from sedation to intraoperative testing 19 . Benzodiazepines are rarely used in awake craniotomy because they may interfere with the electrocorticography testing and may result to hallucinations on emergence or possible delayed recovery 20 .…”

“…It also does not interact or has minimal effects on electrocorticography. A bolus of 1 mcg/kg is administered for 10 minutes followed by an infusion titrated from 0.2 to 0.7 mcg/kg/h 18,19 . However, at high doses and extended use, bradycardia, and prolonged recovery have been reported.…”