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CC BY-NC-ND 4.0 · Asian J Neurosurg 2024; 19(04): 760-766
DOI: 10.1055/s-0044-1791269
Original Article

Efficacy of Ketamine as an Adjuvant to Scalp Block for Hemodynamic Stability in Patients Undergoing Elective Craniotomy for Supratentorial Glioma: A Prospective Randomized Controlled Trial

Ashutosh Kaushal
1   Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Sharmishtha Pathak
2   Department of Anaesthesiology, Pain Medicine and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Delhi, India
,
Priyanka Gupta 
3   Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Praveen Talwar
3   Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
,
Anuj Jain
1   Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
,
Sunaina Tejpal Karna
1   Department of Anaesthesiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Abstract

Introduction Scalp nerve block (SNB) attenuates the hemodynamic response to pin insertion and delivers excellent postoperative analgesia. This study aimed to evaluate the efficacy of SNB using ketamine as an adjuvant to bupivacaine on perioperative hemodynamic responses and postoperative pain in patients undergoing craniotomy for supratentorial glioma.

Materials and Methods Sixty patients were randomized into two groups. They were given scalp nerve block either with bupivacaine and saline (group S) or bupivacaine and ketamine (group K). Primary outcome was to compare the change in mean arterial pressure (MAP) and heart rate (HR) at defined time points from baseline. Secondary outcomes included time to request for first analgesia, total analgesic consumption in intraoperative and postoperative periods till 24 hours, and numeric rating scale pain score at various time points in postoperative period till 24 hours.

Results Fifty-seven patients were included in analysis. HR and MAP were comparable intraoperatively till closure. As soon as closure began, a significant increase in HR (group K vs. group S, 69.76 ± 9.03 vs. 93.96 ± 9.98, p-value = < 0.0001) and MAP (group K vs. group S, 79.4 ± 4.12 vs. 87.17 ± 12.67, p-value = 0.002) was noted in group S patients. This increase persisted in the postoperative period as well. The median total opioid consumed during intraoperative period in group K was 200 mcg versus 300 mcg in group S, p-value < 0.0001.

Conclusion Adding ketamine as an adjuvant to bupivacaine for SNB not only provides significant hemodynamic stability but also reduces both intra- and postoperative analgesic consumption.

Keywords

ketamine - numeric rating scale (NRS) - opioid - rescue analgesia - scalp nerve block

Note

This manuscript was first presented at the ASNACC-2023 virtual conference, which convened from February 23rd to 25th, 2023.




Publication History

Article published online:
27 September 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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