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.

Background: Intraoperative mapping techniques maximize safety and efficacy during perirolandic glioma resection but may induce seizures and limit the procedure. We aim to report the incidence and predictors of stimulation-induced seizures during mapping either patient is awake or under general anesthesia (GA). Methods: Retrospective analysis of 64 patients (40 awake and 24 GA) with perirolandic glioma underwent resection using intraoperative mapping techniques between 2014 and 2019. Preoperative data, operative details, postoperative neurological status, and extent of resection (EOR) were analyzed. Predictors of intraoperative seizures were assessed. Results: The mean cortical and subcortical stimulation intensities needed to evoke motor responses were significantly lower in awake cases than in GA patients (4.9 ± 0.42 vs. 8.9 ± 1.2 mA) and (8.3 ± 0.62 vs. 12.1 ± 1.1 mA), respectively (P = 0.01). Incidence of intraoperative seizures was lower but statistically non-significant in awake cases (10% vs. 12.5%) (P = 0.76). Preoperative multiple antiepileptic drugs (AEDs) (P = 0.03) and low-grade glioma (P = 0.04) were statistically significant predictors for intraoperative seizures. Mean EOR in awake cases was 92.03% and 90.05% in GA cases (P = 0.23). Postoperative deficits were permanent after 3 months only in 5% of awake patients versus 8.3% of GA group (P = 0.59). Conclusion: Awake craniotomy with intraoperative mapping can be done safely for perirolandic gliomas with lower but statistically nonsignificant incidence of intraoperative seizures and this could be attributed to statistically significant lower stimulation intensities required for mapping. Preoperative multiple AEDs and low-grade glioma are significant predictors for intraoperative seizures.

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During brain tumour resection a lot of noxious stimuli are released resulting in a significant hemodynamic and stress response, its control is challenging during anaesthesia, and can be evaluated by monitoring blood pressure (BP), heart rate (HR) Attenuating autonomic cardiovascular responses to pain resulting from skull pinning, skin incision, and craniotomy are considered significant benefits of Regional Scalp Block (RSB) in addition to reducing postoperative analgesic requirements. This study aims to evaluate the effect of preoperative regional scalp block (RSB) versus intraoperative intravenous fentanyl for attenuating intraoperative surgical stress response to supratentorial craniotomy in adult patients under general anaesthesia. The study included 30 patients randomly distributed into two equal groups with 15 patients in each, Group A: Preoperative RSB was done after induction of general anaesthesia and before skull pinning, Group C: Control group: patients were given conventional intraoperative analgesia in the form of intravenous fentanyl with no block. This study included patients with Supratentorial brain tumours were admitted to Zagazig University Hospitals. Patients have been gathered over two years duration from march 2018 to march 2020. The results showed that there were highly significant differences between RSB group and control group. Preoperative RSB showed advantages over Standard analgesia in terms of better attenuation of stress response to pain in the form of heart rate and blood pressure intraoperatively, decrease opioid consumption, lower Visual Analogue Score (VAS), Preoperative RSB can be performed easily in a short time with very high success rate allowing better intraoperative control of haemodynamics, less postoperative pain. We recommend using preoperative RSB in supratentorial craniotomy as a gold standard in our hospital to get the advantages mentioned above.