Effect of clonidine, by infiltration and by intravenous route, on scalp block for supratentorial craniotomy

  • Sananta Kumar Dash Indian Medical Council
  • Kundan S Gosavi Indian Medical Council
  • Harshel G Parikh Indian Medical Council
  • Bharti Kondwilkar Indian Medical Council
Keywords: Scalp block, Clonidine, Supratentorial craniotomies

Abstract

Background: The aim of this research was to study and compare the haemodynamic and analgesic effects of (A) scalp block with bupivacaine 0.25%; (B) scalp block with bupivacaine 0.25% plus clonidine 2 μg/kg; and (C) scalp block with bupivacaine 0.25%, plus intravenous (IV) clonidine 2 μg/kg in supratentorial craniotomies. Method: Sixty patients divided into three equal groups (A, B and C) were administered one of the above combinations. All the patients received propofol-based general anaesthesia. Propofol infusion was started at 25 μg/kg/minute, adjusted with an increment or decrement of 5 μg/kg/minute to obtain an A-line ARX index (AAI) of between 20 and 30 throughout the surgery, and stopped after dural closure. Fentanyl 0.5 μg/kg IV was given if a 20% increase in either heart rate (HR) and/or blood pressure (BP) was observed. HR and BP were monitored throughout the surgery and recorded on pin application, incision (planned 15 minutes after pins), at 15-minute intervals thereafter until dural closure, and every five minutes after dural closure. Propofol and fentanyl requirements were recorded for the duration of the surgery. Results: There was a significant fall in HR, SBP (systolic blood pressure), MAP (mean arterial blood pressure) and RPP (rate-pressure product) after pin application in group B (HR p = 0.018, SBP p = 0.003, MAP p = 0.0042, RPP p = 0.000) and group C (HR p = 0.412, SBP p = 0.01, MAP p = 0.0084, RPP p = 0.001) when compared to group A. Propofol and fentanyl requirements were significantly lower in group B (propofol 67.9% and fentanyl 34.85% less) and group C (propofol 59.21% and fentanyl 36.36% less) when compared to group A. Conclusions: The addition of clonidine, either to the scalp block or intravenously, offers better haemodynamic stability intraoperatively, and reduces analgesic and anaesthetic requirements.

Author Biographies

Sananta Kumar Dash, Indian Medical Council
Resident Doctor Department of Anesthesia and Critical care J J Hospital Mumbai
Kundan S Gosavi, Indian Medical Council
Lecturer Department of Anesthesia and Critical care J J Hospital Mumbai
Harshel G Parikh, Indian Medical Council
Resident Doctor Department of Anesthesia and Critical care J J Hospital Mumbai
Bharti Kondwilkar, Indian Medical Council
Professor and Head
Published
2010-12-14
Section
Original Research