Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial

Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesion...

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Autores principales: Georgene Singh, Ganesamoorthi Arimanikam, Karen R. Lionel, V. Smita, Bijesh Yadav, Appavoo Arulvelan, Manikandan Sethuraman
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Publicado: Thieme Medical and Scientific Publishers Pvt. Ltd. 2020
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spelling oai:doaj.org-article:8e86307bb8424cb4a6da1615937053182021-12-02T23:53:13ZComparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial2348-05482348-926X10.1055/s-0040-1715710https://doaj.org/article/8e86307bb8424cb4a6da1615937053182020-09-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.1055/s-0040-1715710https://doaj.org/toc/2348-0548https://doaj.org/toc/2348-926XBackground The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application. Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events. Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p < 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events. Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.Georgene SinghGanesamoorthi ArimanikamKaren R. LionelV. SmitaBijesh YadavAppavoo ArulvelanManikandan SethuramanThieme Medical and Scientific Publishers Pvt. Ltd.articleropivacainescalp blockdexmedetomidinehemodynamic responseAnesthesiologyRD78.3-87.3ENJournal of Neuroanaesthesiology and Critical Care, Vol 08, Iss 03, Pp 180-186 (2020)
institution DOAJ
collection DOAJ
language EN
topic ropivacaine
scalp block
dexmedetomidine
hemodynamic response
Anesthesiology
RD78.3-87.3
spellingShingle ropivacaine
scalp block
dexmedetomidine
hemodynamic response
Anesthesiology
RD78.3-87.3
Georgene Singh
Ganesamoorthi Arimanikam
Karen R. Lionel
V. Smita
Bijesh Yadav
Appavoo Arulvelan
Manikandan Sethuraman
Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
description Background The insertion of the skull pin head holder to stabilize the head during neurosurgery causes significant periosteal stimulation, resulting in hemodynamic responses, which may lead to brain edema, intracranial hypertension, and hemorrhage in patients with intracranial space-occupying lesions and intracranial aneurysms. We compared the efficacy of dexmedetomidine infusion and 0.5% ropivacaine scalp block in attenuating the hemodynamic response to the skull pin application. Methods A total of 65 American Society of Anesthesiologists (ASA) class I and II patients aged between 18 and 65 years with a preoperative Glasgow Coma Scale score of 15 undergoing elective craniotomy were randomized to receive either a bolus of 1mcg/kg of dexmedetomidine followed by an infusion of 1 mcg/kg/hour (group D) or a scalp block with 0.5% ropivacaine (group S) in a single-blinded comparator study. Patients were monitored for the following hemodynamic changes following skull pin insertion: heart rate (HR), mean arterial pressure (MAP), the requirement of additional analgesia/anesthesia, and adverse events. Results HR and MAP were comparable between the groups at baseline, before induction, and before pin insertion. HR and MAP at 1, 2, and 3 minutes after skull pin insertion were significantly higher in group D as compared with group S (p < 0.05) and were comparable between the groups at 5 minutes. The groups were comparable with respect to the requirement of additional analgesia, anesthesia, and incidence of adverse events. Conclusion Scalp block with 0.5% ropivacaine is effective and superior to dexmedetomidine in attenuating the hemodynamic response to skull pin insertion in ASA I and II neurosurgical patients undergoing craniotomy. However, the hemodynamic effects achieved with dexmedetomidine were within the permissible limits.
format article
author Georgene Singh
Ganesamoorthi Arimanikam
Karen R. Lionel
V. Smita
Bijesh Yadav
Appavoo Arulvelan
Manikandan Sethuraman
author_facet Georgene Singh
Ganesamoorthi Arimanikam
Karen R. Lionel
V. Smita
Bijesh Yadav
Appavoo Arulvelan
Manikandan Sethuraman
author_sort Georgene Singh
title Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
title_short Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
title_full Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
title_fullStr Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
title_full_unstemmed Comparison of Dexmedetomidine Infusion versus Scalp Block with 0.5% Ropivacaine to Attenuate Hemodynamic Response to Skull Pin Insertion in Craniotomy: A Prospective, Randomized Controlled Trial
title_sort comparison of dexmedetomidine infusion versus scalp block with 0.5% ropivacaine to attenuate hemodynamic response to skull pin insertion in craniotomy: a prospective, randomized controlled trial
publisher Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate 2020
url https://doaj.org/article/8e86307bb8424cb4a6da161593705318
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