Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study.

BACKGROUND AND AIMS

Skull pin application during craniotomy elicits haemodynamic responses that may be detrimental to the patient. This study evaluates and compares the effects of intravenous (IV) lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine on haemodynamic and stress response to skull pins.

METHODS

This randomised study was conducted on 160 patients aged 18-60 years. Patients for craniotomy with skull pin application were randomly assigned to receive IV lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h (Group L), dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group D), lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h and dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group LD), and normal saline bolus (15 min) followed by 5 mL/h (Group N) for 30 min after skull pin insertion. Haemodynamic variables (heart rate, mean arterial pressure, and bispectral index) and stress response (serum cortisol, prolactin, blood sugar, and neutrophil-lymphocyte ratio (NLR)) were observed at different periods. For group comparisons, a one-way analysis of variance was used for preoperative blood sugar, and the Kruskal-Wallis test was used for heart rate, blood pressure, bispectral index, serum cortisol, serum prolactin, and neutrophil-to-lymphocyte ratio (NLR).

RESULTS

Haemodynamic fluctuations were less in groups D and LD. Group LD had decreased levels of serum cortisol ( < 0.001), prolactin ( = 0.315), and NLR ( = 0.002). Blood sugar increased in all groups but was significant in groups N and D ( < 0.001).

CONCLUSION

The dexmedetomidine-lignocaine infusion is associated with few haemodynamic fluctuations and decreased stress response compared to lignocaine or dexmedetomidine alone, hence better in attenuating skull pin response.