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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.

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



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.


The aim is to compare the effectiveness of scalp block (SB) to 4 μ 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 μ 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.


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.


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


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

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