بررسي تأثير تزريق موضعي بوپيوا- كايين همراه با اپي نفرين در محل كرانيوتومي بر تغييرات هموديناميك حين و پس از عمل؛ كارآزمايي تصادفي شده دو سو كور با كنترل دارونما

The effects of local infiltration of scalp with bupivacaine plus epinephrine in the site of craniotomy on hemodynamic changes during and after surgery, a prospective randomized placebo controlled clinical trial

Background and Objective: After craniotomy, hypertension may result to intracerebral hemorrhage. The aim of this study was to assess the effects of local infiltration of scalp with bupivacaine plus epinephrine in the site of craniotomy on hemodynamic changes during and after surgery and to compare them with control group. Materials and methods: In a prospective randomized placebo controlled clinical trial, 34 adult patients with ASA physical status I or II, undergoing elective craniotomy were enrolled. After induction of general anesthesia, they were randomly assigned to bupivacaine (5 ml bupivacaine 0.25% plus epinephrine 1:200,000) or normal saline (5ml normal saline 0.25% plus epinephrine 1:200,000), according to scalp infiltration solution. Hemodynamic parameters including mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia induction (as base measure), during scalp infiltration, during skin closure, on admission to intensive care unit (ICU), and 1 hr after admission. Results: There were no significant differences regarding the mean of age and sex frequencies between groups. MAP and HR were comparable during first three measurements, but MAP was significantly lower in the bupivacaine group compared with saline group at 1 hr after ICU admission (respectively 97.3±8.5 vs. 102.8±6.6 mmHg, P=0.043). HR was significantly slower in the bupivacaine group at ICU admission and lhr after admission in comparison with saline group (79.25±7.3 vs. 85.1±8.9 beat/min, P=0.044 and 83.3±5.4 vs. 88.2± 5.1 beat/min P= 0.011). Conclusions: Scalp infiltration in the site of craniotomy with bupivacaine 0.25% plus epinephrine would significantly lower hemodynamic variables in postoperative period and its application in craniotomy surgeries is recommended.