A0035 Effect of Scalp Block and Ultrasound-Guided Transverse Abdominis Plane Block on Intraoperative Hemodynamics and Perioperative Analgesia in Abdominal Bone Flap Cranioplasties: A Prospective, Randomized, Double-Blinded Study

Background: Regional techniques provide good perioperative analgesia and stable intraoperative hemodynamics but sparsely used in neuroanesthesia. This study assessed the effect of scalp block and ultrasound-guided transverse abdominis plane (TAP) block with 1 µg/kg clonidine as adjuvant to 0.2% ropivacaine versus intravenous fentanyl (0.1 µg/kg/h) on intraoperative hemodynamics and perioperative analgesia in abdominal bone flap cranioplasties (ABFC).

Materials and Methods: Sixty ASAI, II, and III patients undergoing ABFC were randomly divided into two groups of 30 each to receive either ropivacaine + clonidine in scalp and TAP block and IV saline infusion (group T) or saline in scalp and TAP block and IV fentanyl infusion (group C) after general anesthesia. Intraoperatively IV fentanyl (1 µg/kg) was given as supplemental analgesic when there was > 20% rise in hemodynamics above baseline. Postoperatively, paracetamol 1 g IV was given, when VAS scores were ≥ 4. Intraoperative hemodynamics, opioid requirement, postoperative duration of analgesia, VAS scores, and total analgesic requirement were noted. Data were analyzed using chi-square test/Fisher's exact test for categorical data and the Mann-Whitney test/unpaired t-test for quantitative data.

Results: Intraoperatively, stable hemodynamics, reduced fentanyl requirement (µg/kg) (0.06 ± 0.04 vs. 1.73 ± 0.52) and, postoperatively, prolonged duration of analgesia (minutes) (1,056 ± 364.6 vs. 394 ± 202.2), better VAS scores (2.5 ± 0.7 vs. 3.2 ± 0.7), and reduced total analgesic requirement (grams) (1 ± 0.8 vs. 3 ± 0.6) were found in group T as compared with group C.

Conclusions: Regional techniques with adjuvant along with general anesthesia offers better hemodynamic stability and perioperative analgesia in ABFC surgeries.