Intravenous Fentanyl 4 μg per kg Administered before Scalp Pin Application is Inferior to Scalp Block in Preventing Hemodynamic Changes

BACKGROUND: Application of scalp pins for craniotomy surgeries is a noxious stimulus, causing tachycardia and hypertension, resulting in increased cerebral blood flow and elevated intracranial pressure, hence measures to attenuate this will have beneficial role. AIMS: The aim is to compare the effectiveness of scalp block (SB) to 4 μg.kg(-1) intravenous (i.v) fentanyl in attenuating hemodynamic response to scalp pin application in patients who underwent elective craniotomy under general anesthesia. SETTINGS AND DESIGN: The study design involves prospective, randomized study conducted at Tertiary care center/hospital. SUBJECTS AND METHODS: Forty-four American Society of Anesthesiologists physical status Classes l and II patients were randomly allocated into the following groups: Group-SB (n = 22) received SB using 0.25% injection bupivacaine and Group-F (n = 22) received 1 μg.kg(-1) i.v fentanyl. Patient's heart rate (HR) and mean arterial pressure (MAP) were recorded from the application of pins till 60 min and rescue analgesic/anesthetic agents and their dosage were noted. Statistical analysis was performed comparing HR and MAP changes to application of scalp pins. STATISTICAL ANALYSIS: Software developed by the Centre for Disease Control, Atlanta, namely Epidemiological Information Package 2010 was used to derive statistical variables. RESULTS: Patients were comparable in age, gender, hypertension as comorbidity, baseline HR, and MAP. Significant rise in HR was noted in Group-F till 20(th) min compared to Group-SB. MAP was high from application of pins till 60(th) min in Group-F compared to Group-SB. Requirement of rescue analgesics/anesthetics was high in Group-F compared to Group-SB. CONCLUSION: SB effectively attenuates hemodynamic response to application of scalp pins in patients undergoing elective craniotomy and reduces requirement of rescue analgesic and/or anesthetics.