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Anesth Essays Res. 2019 Oct-Dec;13(4):625-630. doi: 10.4103/aer.AER_107_19. Epub 2019 Dec 16.

Intravenous Fentanyl 4 μg per kg Administered before Scalp Pin Application is Inferior to Scalp Block in Preventing Hemodynamic Changes.

Author information

1
Department of Anesthesiology, Karwar Institute of Medical Sciences, Karwar, Karnataka, India.
2
Department of Anesthesiology, Kodagu Institute of Medical Sciences, Madikeri, Karnataka, India.

Abstract

Background:

Application of scalp pins for craniotomy surgeries is a noxious stimulus, causing tachycardia and hypertension, resulting in increased cerebral blood flow and elevated intracranial pressure, hence measures to attenuate this will have beneficial role.

Aims:

The aim is to compare the effectiveness of scalp block (SB) to 4 μg.kg-1 intravenous (i.v) fentanyl in attenuating hemodynamic response to scalp pin application in patients who underwent elective craniotomy under general anesthesia.

Settings and Design:

The study design involves prospective, randomized study conducted at Tertiary care center/hospital.

Subjects and Methods:

Forty-four American Society of Anesthesiologists physical status Classes l and II patients were randomly allocated into the following groups: Group-SB (n = 22) received SB using 0.25% injection bupivacaine and Group-F (n = 22) received 1 μg.kg-1 i.v fentanyl. Patient's heart rate (HR) and mean arterial pressure (MAP) were recorded from the application of pins till 60 min and rescue analgesic/anesthetic agents and their dosage were noted. Statistical analysis was performed comparing HR and MAP changes to application of scalp pins.

Statistical Analysis:

Software developed by the Centre for Disease Control, Atlanta, namely Epidemiological Information Package 2010 was used to derive statistical variables.

Results:

Patients were comparable in age, gender, hypertension as comorbidity, baseline HR, and MAP. Significant rise in HR was noted in Group-F till 20th min compared to Group-SB. MAP was high from application of pins till 60th min in Group-F compared to Group-SB. Requirement of rescue analgesics/anesthetics was high in Group-F compared to Group-SB.

Conclusion:

SB effectively attenuates hemodynamic response to application of scalp pins in patients undergoing elective craniotomy and reduces requirement of rescue analgesic and/or anesthetics.

KEYWORDS:

Blood pressure; craniotomy; fentanyl; heart rate; scalp block; scalp pins

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