Padhy Narmada, Moningi Srilata, Kulkarni Dilip K, Alugolu Rajesh, Inturi Srikanth, Ramachandran Gopinath
Department of Anesthesia and Intensive Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
J Anaesthesiol Clin Pharmacol. 2020 Apr-Jun;36(2):207-212. doi: 10.4103/joacp.JOACP_249_18. Epub 2020 Jun 15.
Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision.
After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software.
The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. ( = 0.02 at T1, = 0.03 at T2).
Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.
神经外科手术中的周围神经阻滞可减轻大多数应激反应，如针刺、皮肤和硬脑膜切开。头皮阻滞是传统的首选阻滞方法。需要进一步研究侵入性较小的技术。蝶腭神经节经鼻黏膜阻滞在慢性头痛和面部疼痛患者中已显示出有前景的结果。我们研究的主要目的是比较金标准头皮阻滞和双侧蝶腭神经节阻滞（经鼻途径）对针刺引起的血流动力学反应的减轻作用。次要目的包括对皮肤和硬脑膜切开的血流动力学反应。
在获得机构审查委员会批准并取得知情同意后，对50例接受择期幕上手术的成年患者进行了一项前瞻性随机对照研究。记录两组患者对针刺、皮肤切开和硬脑膜切开的血流动力学反应。使用NCSS 9.0统计软件对数据进行分析。
两组之间的心率和平均动脉压相当。在硬脑膜切开后，SPG组在1、2、3、4、5和10分钟时平均动脉压显著降低，而S组在1和2分钟时显著降低。（T1时P = 0.02，T2时P = 0.03）。
在开颅手术期间，双侧SPG阻滞与全身麻醉联合使用是一种有效且安全的替代技术，可替代头皮阻滞以减轻有害刺激引起的血流动力学反应。
