Pain relief for scalp pin application

The skull pin application in neurosurgical procedures were used to stabilize head position for surgery. They lead to intense noxious stimuli and increase in HR, MAP, plasma catecholamine and CBF even when the patients are under general anaesthesia. In patients with intracranial lesion due abnormal autoregulation are prone for raise in ICP with increase in MAP . These adverse effect can lead to acute cerebral edema and herniation of brain. Different techniques were employed to reduce this pin response-scalp block or pin site infiltration with local anaesthetic, opioids, shortacting β -blockers, deepening of anaesthesia with inhalation and α-2 agonist. Scalp block with local anaesthetics played major role in attenuating the hemodynamic effects as well as the sympathoadrenal response to skull pin insertion. Dexmedetomidine is selective alpha 2 agonist which has sedation, anaesthetic sparing and analgesic properties. It decreases thehemodynamic response in dose dependent fashion. It can be used as adjuvant for maintenance of anaesthesia in neurosurgical patients. In our study we compared Scalp block with Dexmedetomidine infusion in attenuation of pin response in neurosurgical patients.