Efficacy of Adding Dexmedetomidine to Bupivacaine on Attenuating Hemodynamic Response to Skull Pin Placement for Performing Scalp Block
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 12
Abstract
Introduction: Acute increases in heart rate and arterial blood pressure can be deleterious in the neurosurgical patient with increased ICP or with cerebral aneurysms. So present study was done to evaluate the efficacy of adding dexmedetomidine to bupivacaine for performing scalp block on attenuating hemodynamic response to skull pin placement. Material and Methods: This was a prospective, randomised, double-blinded study conducted from November 2009 to September 2010 in which 50 patients of either sex were selected. Patients were randomly allocated to one of the two groups(25 each), Group 1 received scalp block with a 20 ml solution having Dexmedetomidine 1mcg/kg and 0.25% bupivacaine. Group 2 received scalp block with 20 ml of 0.25% bupivacaine. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure(DBP) and mean blood pressure (MBP) were recorded at base line (pre induction), before block, before pin placement, during pin placement and later at 1, 3, 5, and 8 minute intervals. Hemodynamic changes in response to pin fixation were compared with the baseline in each group. Also the hemodynamic parameters at each step of recording were compared between the two groups. Results: There is a significant difference between the two groups, with the mean heart rate of G2 (bupivacaine only) group showing a significant increase during pin placement and one minute after that. In G1 (dexmedetomidine + bupivacaine 0.25%) group , there was no increase in mean heart rate during and 8 minutes after pin placement. In group 1 (dexmedetomidine + bupivacaine 0.25% group) pinning did not result in an increase in MAP from 91.49 ±10.96mmHg to 89.42 ± 16.56 mmHg (P<0.01). Inter-group comparison showed significant increase in MAP in group 2 at each step of recording. In group 1 (dexmedetomidine + bupivacaine 0.25% group) pinning did not result in an increase in SBP and DBP. Inter-group comparison showed significant increase in SBP and DBP in group 2 at each step of recording. There was no statistically significant difference in oxygen saturation between the two study groups during the study period. Conclusion: This study demonstrates that adding dexmedetomidine to bupivacaine while performing scalp block is very efficient in obtunding hemodynamic response to skull pin placement.
Authors and Affiliations
Anne Kiran Kumar, Mohammad Rahmathullah, Dilip Kumar Kulkarni, Gopinath Ramachandran
Keywords
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