Bharne Sidhesh, Bidkar Prasanna Udupi, Badhe Ashok Shankar, Parida Satyen, Ramesh Andi Sadayandi
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Asian J Neurosurg. 2016 Jan-Mar;11(1):60-5. doi: 10.4103/1793-5482.165801.
The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes.
Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min.
The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P < 0.05). No adverse effects were noted.
Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.
颅骨钉在神经外科手术中的应用是一种极具伤害性的刺激，可引起血流动力学变化及频谱熵水平升高。我们设计了一项研究，比较静脉注射拉贝洛尔和布比卡因头皮阻滞对减轻这些变化的效果。
66例行择期神经外科手术的患者被随机分为两组，每组33例，分别为L组（拉贝洛尔组）和B组（布比卡因组）。使用芬太尼、丙泊酚和维库溴铵进行标准诱导后，患者行气管插管。记录基线血流动力学参数和熵水平。在应用颅骨钉前5分钟，L组患者静脉注射拉贝洛尔0.25mg/kg，B组患者用30ml 0.25%布比卡因行头皮阻滞。应用颅骨钉后，在5分钟内的不同时间点记录心率（HR）、收缩压（SAP）、舒张压（DAP）、平均动脉压（MAP）以及反应熵（RE）/状态熵（SE）。
两组患者的人口统计学特征具有可比性。基线血流动力学参数和熵水平也相似。应用颅骨钉后，两组患者的HR、SAP、DAP、MAP以及RE/SE均升高，但头皮阻滞组患者的上述指标较低。L组HR升高19.8%，B组升高11%。L组SAP升高11.9%，B组无变化。L组DAP升高19.7%，B组升高9.9%，L组MAP升高15.6%，B组升高5%（P<0.05）。未观察到不良反应。
在减轻颅骨钉应用后血流动力学参数升高及熵变化方面，布比卡因头皮阻滞比静脉注射拉贝洛尔更有效。
