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KMID : 1040020150060010001
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International Journal of Pain
2015 Volume.6 No. 1 p.1 ~ p.7
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Effective Concentration of Ropivacaine for Scalp Block during Brain Surgery
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Lim Chang-Hun
Park Hwan-Chul
Park Keun-Suk
Heo Bong-Ha
Choi Jeong-Il
Yoon Myung-Ha
Kim Woong-Mo
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Abstract
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Background: Surgical stimulations, such as skull pinning, skin incision, craniotomy, or dural incision during brain surgery may result in an elevated mean arterial pressure (MAP) or heart rate (HR) which may increase the risk of hemorrhage or elevated intracranial pressure. The current study compared the efficacy and the side effects of scalp block using different concentrations of ropivacaine in patients undergoing brain surgery.
Methods: 45 ASA physical status I or II patients, scheduled for elective aneurysm clippings or tumor removals under craniotomy, were enrolled and allocated into one of three groups; Group A (0.25% ropivacaine), Group B (0.5% ropivacaine), Group C (0.75% ropivacaine). General anesthesia was induced and maintained with propofol and remifentanil using target-controlled infusion (TCI) system. Scalp block was performed by blocking the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, and greater and lesser occipital nerves bilaterally using 20 ml ropivacaine. MAP and HR were recorded just prior to the surgical stimulations and measured at 1-minute intervals thereafter for five minutes. Hypotension (MAP < 60 mmHg) and bradycardia (HR < 50 beats/min) were checked during the surgery.
Results: The increase of MAP and HR in response to pin insertion was blunted in Group B or C but not in Group A. MAP in Group C was significantly lower compared to other groups at the time of craniotomy and dural incision.
Conclusions: These data suggest that the 0.5% ropivacaine is the most appropriate concentration among the three concentrations for the scalp block to provide hemodynamic stability during brain surgery.
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KEYWORD
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scalp block, brain surgery, ropivacaine, local anesthetic toxicity, skull pinning
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