A comparsion between intravenous dexmedetomidine and bupivacaine scalp block in attenuating the hemodynamic response to skull pin head holder application in neurosurgical patients

A comparsion between intravenous dexmedetomidine and bupivacaine scalp block in attenuating the hemodynamic response to skull pin head holder application in neurosurgical patients CTRI/2022/04/041989 [Registered on: 20/04/2022] Trial Registered Prospectively A comparison between intravenous dexmedetomidine and bupivacaine scalp block in attenuating hemodynamic response to skull pin application in neurosurgical patients Introduction: The skull pin application lead to intense noxious stimuli and increase in HR, MAP, plasma catecholamine and CBF even when the patients are under general anaesthesia. Aim and objectives: To compare the efficacy of intravenous Dexmedetomidine infusion with 0.5% Bupivacaine scalp block in attenuating the hemodynamic response, to the skull pin head holder application in neurosurgical patients. Methods: Sixty patients of ASA I & II posted for elective craniotomy were taken in the study, Group S(30) –Patients received scalp block with injection Bupivacaine 0.5% 30ml prior pin application Group D(30)-Patients received intravenous Dexmedetomidine 0.5mcg/kg i.v loading dose and 0.25mcg/kg/hr Results: Demographic parameters was comparable between two groups . Heart rate (HR) variation between Group S and Group D was comparable. Dexmedetomidine after intubation did not completely attenuate the cardiovascular response.The SBP & DBP & MAP between two groups was comparable Single bolus administration of injection Fentanyl 1mcg/kg was needed in 4/7 patients and increased inhalational concentration was needed in 1/7 patients in Group S, both methods were needed in 2/7 patients in Group S. The adverse hemodynamic events was comparable. The 0.5% Bupivacaine (Rs 85)was cost effective when compared with the Dexmedetomidine 50mcg/ml(Rs 170) Conclusion We conclude that the Scalp block with 0.5% Bupivacaine was better than Dexmedetomidine infusion in attenuating the hemodynamic response to skull pin head holder application in neurosurgical patients.

静脉输注右美托咪定(Dexmedetomidine)与布比卡因(Bupivacaine)头皮阻滞在减轻神经外科患者颅骨钉头架安装时血流动力学反应中的对比研究 临床试验注册号：CTRI/2022/04/041989 [注册日期：2022年4月20日] 前瞻性注册试验
静脉输注右美托咪定与布比卡因头皮阻滞在减轻神经外科患者颅骨钉安装时血流动力学反应中的对比研究
引言：颅骨钉安装会产生强烈的伤害性刺激，即使患者处于全身麻醉状态下，也会导致心率(Heart Rate, HR)、平均动脉压(Mean Arterial Pressure, MAP)、血浆儿茶酚胺及脑血流量(Cerebral Blood Flow, CBF)升高。
研究目的与目标：对比静脉输注右美托咪定与0.5%布比卡因头皮阻滞在减轻神经外科患者颅骨钉头架安装时血流动力学反应中的有效性。
方法：本研究纳入60例美国麻醉医师协会(American Society of Anesthesiologists, ASA)分级Ⅰ~Ⅱ级、拟行择期开颅手术的患者，分为两组（每组30例）：S组——于颅骨钉安装前给予0.5%布比卡因注射液30ml行头皮阻滞；D组——给予静脉负荷剂量右美托咪定0.5μg/kg，随后以0.25μg/kg/h的速率维持输注。
结果：两组患者的人口统计学参数无显著差异。S组与D组的心率变化无统计学差异。气管插管后应用右美托咪定无法完全抑制心血管反应。两组患者的收缩压(Systolic Blood Pressure, SBP)、舒张压(Diastolic Blood Pressure, DBP)及平均动脉压(MAP)均无显著差异。S组中，4/7的患者需单次静脉注射芬太尼1μg/kg，1/7的患者需提高吸入麻醉药物浓度，另有2/7的患者需同时采用上述两种处理方式。两组不良血流动力学事件的发生情况无显著差异。与50μg/ml规格的右美托咪定（售价170卢比）相比，0.5%布比卡因（售价85卢比）具备成本效益优势。
结论：本研究表明，在减轻神经外科患者颅骨钉头架安装时的血流动力学反应方面，0.5%布比卡因头皮阻滞的效果优于静脉输注右美托咪定。