PRE-EMPTIVE COMBINED TRAMADOL/BUPIVACAINE SCALP BLOCK FACILITATES OPERATIVE PROCEDURE AND POST-OPERATIVE NEUROLOGIC ASSESSMENT AFTER ELECTIVE SUPRATENTORIAL BRAIN TUMOR RESECTION

Objectives: This study aimed to evaluate the impact of preemptive scalp tramadol block with and without bupivacaine compared to bupivacaine block alone on the feasibility and outcome of craniotomy for supratentorial brain tumor resection. Patients Methods: The study included 40 patients assigned for elective craniotomies for supratentorial brain tumor resection. Patients were randomly divided into 4 equal groups: Control group included patients who received no scalp block, Group IIpatients received scalp block using 0.25% bupivacaine alone, Group IIIpatients received scalp block using tramadol alone (1 mg/kg) and Group patients IV received scalp block using combination of bupivacaine and tramadol in half the calculated dose. Cranial pointed pins in the Mayfield™ head holder were inserted 10 minutes after scalp block. Systolic (SAP), diastolic (DAP), and meanarterial pressures (MAP) were recorded 5-min after the induction of anesthesia (T1), during performance of block (T2) and at 1-min (T3) and 5-min (T4) after pinning. Postoperative (PO) analgesia was assessed using 10-points visual analogue (VAS) pain scale for 48 hours and duration of analgesia and the frequency of requests of rescue analgesia were recorded. Surgeon satisfaction regarding intraoperative brain status; whether tense or slack and feasibility of P.O. neurological assessment were judged and expressed as yes or no. Results: At T2 and T3 measures, blood pressure measures were significantly lower in studied groups compared to control group with significantly lower measures in groups III and IV compared to group II. At T4, blood pressure measures returned to near baseline levels in groups III and IV with significantly lower SAP and MAP compared to groups I and II. Mean percentage of changes of blood pressure measures were significantly higher in group I compared to other groups and in group II compared to groups III and IV. All patients enrolled in group I required control measures to lower blood pressure, while only 9 patients (30%%) of studied patients were in need. Total pain VAS score was significantly higher with significantly shorter duration of analgesia in control versus study groups and in group IV compared to groups II and III. Scalp block in study groups significantly reduced the frequency of consumption of rescue analgesia. Surgeon s satisfaction rate was 86.7% and 97.7% concerning the intraoperative brain status and feasibility of P. O. neurologic assessment with scalp block compared to control group respectively. Conclusion: Scalp block using a combination of tramadol andbupivacaine in half of the dose calculated for weight provided proper hemodynamic control with subsequent satisfactory intraoperative brain status and significant PO pain control in response to pinning. Moreover, it spared the use of PO narcotics and allowed satisfactory P. O. neurologic assessment.