THE EFFECTS OF LEVOBUPIVACAINE SCALP BLOCK VERSUS DEXMEDETOMIDINE INFUSION ON HEMODYNAMIC RESPONSE TO SKULL PIN INSERTION IN PATIENTS UNDERGOING ELECTIVE CRANIOTOMY: A RANDOMIZED BLINDED CLINICAL COMPARATIVE STUDY

Dr. Chandita Konwar, Dr. Neelam Thakuria

Abstract


Background & Aims

The application of skull pin holder elicits an adverse hemodynamic response that can have deleterious effects, which can be attenuated by various drugs. This study was aimed at comparing the effects of levobupivacaine scalp block versus intravenous dexmedetomidine infusion on hemodynamic response to skull pin insertion in patients undergoing elective craniotomy.

Methods

This randomized, prospective, double blind, single hospital study was carried out after Institutional Ethics Committee Clearance. Seventy nine patients aged 18 to 65 years belonging to ASA classes I and II undergoing elective craniotomy surgeries were randomly allocated into 2 groups - Group A  (n=39): 20mL of 0.5% levobupivacaine scalp block and Group B (n=40):  infusion dexmedetomidine 1mcg/kg over 10 mins followed by 1mcg/kg/hr for 30 minutes after scalp pin insertion. Intraoperative hemodynamics such as Heart rate (HR), Systolic blood pressure (SBP), Diastolic Blood pressure (DBP), Mean arterial pressure (MAP) were recorded at specific intervals.Post operative VAS score were recorded at specific intervals.

Results

The demographic and baseline hemodynamic parameters were comparable. After pinning, the HR, SBP, DBP and MAP were all increased in both the groups which was non significant (p>0.05). At later time intervals the parameters decreased and it was found to be lower in scalp block group. Significant differences in HR and SBP at 10 minutes and 15 minutes (p<0.05) were seen, while for DBP and MAP it was seen at 10 mins after scalp pin insertion. As observed from post operative VAS score scalp block provided better analgesia than dexmedetomidine infusion.

Conclusion

We conclude that though both scalp block with 0.5% levobupivacaine and dexmedetomidine infusion is effective in attenuating hemodynamic response to scalp pin insertion, scalp block provided superior results.


Keywords


Diastolic Blood pressure (DBP),Mean arterial pressure (MAP), Systolic blood pressure (SBP), hemodynamic

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References


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