Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and post-operative analgesia

Abstract

Background: Noxious stimuli during craniotomy may induce hypertension and tachycardia, giving rise to morbidity in patients with intracranial hypertension. Craniotomy is followed by moderate level of postoperative pain. Objective: Evaluate the effectiveness of scalp block on hemodynamic response to noxious stimuli, intraoperative fentanyl requirement and post-operative analgesia. Methods: Sixty patients undergoing elective craniotomy were randomly assigned to receive a scalp block with either 0.5% bupivacaine or 0.25% bupivacaine and 1:200,000 adrenaline (group A and B) or normal saline with 1:200,000 adrenaline (group C). Fentanyl 0.5 mcg/kg was administered for hemodynamic control. Intraoperative mean arterial blood pressure (MAP), heart rate (HR), fentanyl doses, and post-operative pain scores were recorded. Post-operative analgesia was provided by patient-controlled analgesia (PCA) morphine for 24 hours. Results: MAP was greater in group C than group A during pinning and incision (p <0.05), and was greater in group C than group B during pinning, incision and craniotomy (p <0.05). HR differences were not statistically significant between all groups (p >0.05). Intraoperative fentanyl requirement was significantly greater in group C compared with group A and B (p < 0.05). Pain score, time to the first morphine administration and total morphine consumption were not significantly different between all groups. Conclusion: Pre-incision scalp blocks using either 0.25% or 0.5% bupivacaine with 1:200,000 adrenaline were effective to prevent rising of MAP, but not HR in response to cranial pinning and skin incision, causing less intraoperative fentanyl requirement. However, they did not reduce post-craniotomy pain and morphine consumption.

Effect of Scalp Nerve Block with Ropivacaine on Postoperative Pain in Patients Undergoing Craniotomy: A Randomized, Double Blinded Study

“…Jin-Young Hwang et al reported that SNB with 0.75% levobupivacaine at the end of surgery effectively improved recovery profiles including relieving postoperative pain, reducing patient control analgesia (PCA) consumption, and decreasing the requirement of anti-hypertension agents 26 . Lawan Tuchinda et al 3 showed that scalp block with 0.25% and 0.5% bupivacaine can blunt blood pressure and heart rate responses to noxious stimulus. Bala et al 27 observed that scalp block with 0.5% www.nature.com/scientificreports www.nature.com/scientificreports/ bupivacaine, added with 1:400,000 adrenaline after skin closure, decreased pain scores up to 6 hours postoperatively compared to normal saline group in patients who were received supratentorial craniotomies.…”

Perbandingan Antara Fentanil 2 μg/kgBB/jam dan Scalp Block Terhadap Peningkatan Hemodinamik dan Kadar Glukosa Darah Sewaktu Saat Pemasangan Pin Kepala Pada Kraniotomi

“…Meskipun saat ini telah dilakukan berbagai teknik anestesi untuk operasi bedah otak, namun angka kejadian ketidakstabilan hemodinamik pada awal prosedur pembedahan bedah otak saat dilakukan pemasangan pin kepala, insisi kulit kepala, pembukaan periosteum, dan insisi duramater menunjukkan angka kejadian yang cukup tinggi. [1][2] Pin kepala merupakan salah satu alat yang digunakan untuk memfiksasi kepala saat kraniotomi. Pemasangan pin kepala pada scalp akan memicu respons stres yang berpotensi menyebabkan gangguan hemodinamik.…”

“…Scalp block menurunkan kebutuhan opioid dan menurunkan kejadian hipertensi, takikardia, dan stres neuroendokrin. [1][2]9 Penelitian ini bertujuan untuk membandingkan hemodinamik dan kadar glukosa darah sewaktu (GDS) antara fentanil 2 μg/kgBB/jam dan scalp block saat pemasangan pin kepala pada kraniotomi pengangkatan tumor elektif dengan anestesi umum.…”

“…Prosedur intrakranial seperti pemasangan pin kepala, insisi kulit, pembukaan periosteum, dan insisi duramater merupakan suatu manipulasi yang dapat menyebabkan stimulus nyeri nosiseptif. 1,9 Penelitian di Thailand mengungkapkan bahwa saat pemasangan pin kepala merupakan waktu terjadi respons hemodinamik terhadap stimulus nosiseptif paling tinggi dibanding dengan saat insisi kulit, pembukaan periosteum, dan insisi duramater. 1 Oleh karena itu, teknik anestesi pada kraniotomi harus mampu mereduksi respons stres terhadap nyeri selama manipulasi pembedahan.…”

“…1,9 Penelitian di Thailand mengungkapkan bahwa saat pemasangan pin kepala merupakan waktu terjadi respons hemodinamik terhadap stimulus nosiseptif paling tinggi dibanding dengan saat insisi kulit, pembukaan periosteum, dan insisi duramater. 1 Oleh karena itu, teknik anestesi pada kraniotomi harus mampu mereduksi respons stres terhadap nyeri selama manipulasi pembedahan. 4 Solusi mengatasi nyeri pada prosedur kraniotomi selain penggunaan opiod adalah menggunakan teknik scalp block dikombinasikan dengan anestesi umum.…”