Clinical Efficacy of Scalp Infiltration with 0.25% Levobupivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Supratentorial Craniotomies under General Anesthesia

Keywords

craniotomy - levobupivacaine - hemodynamic parameters

Introduction: Sudden hemodynamic changes caused by skull pins in neurosurgery can be prevented by combining scalp block, which blocks both the superficial and deep layers of the scalp. Levobupivacaine has been used in 0.75% and 0.5% concentrations for this purpose. However, no previous study has determined the efficacy of 0.25% levobupivacaine for scalp block.

Aims: To determine the effects of scalp block with 0.25% levobupivacaine on the hemodynamic response to head pinning and incision during craniotomy and evaluate the analgesic requirements intraoperatively.

Methodology/Description: This prospective observational study included 50 patients, after obtaining approval from ethics committee of Grant Government Medical College and Sir J.J. Hospital and written informed consent from patients (ASA status, I or II; age, 18 to 60 years) who underwent supratentorial craniotomy at this institute. Patients with coagulation disorders, inflammatory skin lesions, pre-existing neuropathies, pregnant and lactating mothers were excluded. Scalp block with 20 mL of 0.25% levobupivacaine was given bilaterally after induction of general anesthesia and prior to application of Mayfield skull pin head holder. The hemodynamic parameters were recorded at baseline, during scalp block and after head pin insertion, incision, and at craniotomy.

Results: Values of heart rate and blood pressure before and after anesthesia induction compared with values after painful stimuli were in the 10 to 15% range. Mean intraoperative fentanyl requirement was 150 µg (2–3 µg/kg).

Conclusion: Levobupivacaine (0.25%) when used for scalp block ensures hemodynamic fluctuation of upto 15% during head pinning, incision, and craniotomy without any complications or increased analgesic requirements intraoperatively.

 

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• References

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