Bloomfield E L, Schubert A, Secic M, Barnett G, Shutway F, Ebrahim Z Y
Department of General Anesthesiology, The Cleveland Clinic Foundation, Ohio 44195, USA.
Anesth Analg. 1998 Sep;87(3):579-82. doi: 10.1097/00000539-199809000-00015.
After craniotomy, hypertension may contribute to intracerebral hemorrhage. We studied whether scalp infiltration with bupivacaine during craniotomy reduces postoperative pain and hypertension. In a double-blind fashion, 36 adult patients (ASA physical status II or III) undergoing elective craniotomy were randomly assigned to receive scalp infiltration with either bupivacaine (0.25%) and epinephrine (1:200,000) or saline/ epinephrine (1:200,000) for skeletal fixation, skin incision, and wound closure. Heart rate (HR) and mean arterial pressure (MAP) were measured after anesthesia induction, after skull-pin insertion, after scalp infiltration, during dural closure, during skin closure, on admission to postanesthesia care unit (PACU), and 1 h after admission. Visual analog pain scores were recorded in the PACU. MAP was significantly greater in the saline group at scalp infiltration. HR was significantly faster in the saline group at dural and skin closure. The bupivacaine group reported significantly less pain than the saline group at PACU admission and 1 h after admission. Pain scores did not correlate with hemodynamic measurements. We conclude that scalp infiltration with 0.25% bupivacaine with 1:200,000 epinephrine blunts certain intraoperative hemodynamic responses and reduces postoperative pain but has no effect on postoperative hemodynamics.
We sought to evaluate whether scalp infiltration with bupivacaine and epinephrine at the beginning and end of craniotomy would afford more intra- and postoperative hemodynamic stability and influence immediate postoperative pain. We found that intraoperative hemodynamics were not influenced greatly; however, craniotomy patients do have significant postoperative pain, which does not seem to have an influence on hemodynamics in the postanesthesia care unit.
开颅术后，高血压可能导致脑出血。我们研究了开颅术中布比卡因头皮浸润是否能减轻术后疼痛和高血压。采用双盲方式，将36例接受择期开颅手术的成年患者（美国麻醉医师协会身体状况分级为II或III级）随机分为两组，一组在颅骨固定、皮肤切口和伤口缝合时接受布比卡因（0.25%）和肾上腺素（1:200,000）头皮浸润，另一组接受生理盐水/肾上腺素（1:200,000）头皮浸润。在麻醉诱导后、颅骨钉插入后、头皮浸润后、硬脑膜关闭时、皮肤关闭时、进入麻醉后护理单元（PACU）时以及进入PACU 1小时后测量心率（HR）和平均动脉压（MAP）。在PACU记录视觉模拟疼痛评分。头皮浸润时生理盐水组的MAP显著更高。硬脑膜和皮肤关闭时生理盐水组的HR显著更快。布比卡因组在进入PACU时和进入PACU 1小时后的疼痛报告明显少于生理盐水组。疼痛评分与血流动力学测量结果无关。我们得出结论，0.25%布比卡因与1:200,000肾上腺素头皮浸润可减弱某些术中血流动力学反应并减轻术后疼痛，但对术后血流动力学无影响。
我们试图评估在开颅术开始和结束时布比卡因和肾上腺素头皮浸润是否能提供更多术中和术后血流动力学稳定性并影响术后即刻疼痛。我们发现术中血流动力学未受很大影响；然而，开颅手术患者确实有明显的术后疼痛，这似乎对麻醉后护理单元的血流动力学没有影响。
