J Med Assoc Thai 2018; 101 (9):59

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The Effect of 0.5% Levo-Bupivacaine Scalp Block during Craniotomy: A Double-Blind Randomized Placebo Controlled Trial
Raksakietisak M Mail, Suwansukroad P , Uengkajornkul T , Rushatamukayanunt P

Objective: The objectives of the present study are to evaluate the scalp block efficacy in term of perioperative use of analgesic (fentanyl), awakening time, hemodynamic stability and postcraniotomy pain control.

Materials and Methods: One hundred and thirty (l8 to 75 years old) patients were enrolled and allocated into 2 groups by computer-generated randomization. Group N received scalp block with 0.9% Normal saline solution [NSS] and group L received scalp block with 0.5% levo-bupivacaine l0 to l5
mL. Both groups also received pre-incisional local anesthetic infiltration from neurosurgeons due to their routine practice (a mixture of 0.5% bupivacaine l0 mL and l% lidocaine with epinephrine l: 200,000 l0 mL) and intravenous fentanyl for intra-operative pain control. The assessed outcomes were intra- operative total fentanyl consumption, hemodynamic stability, awakening time, pain scores, postoperative morphine consumption, nausea and vomiting.

Results: One hundred and twenty-eight patients were analyzed with 64 patients in each group. There were no differences in patient demographics, fentanyl consumption, and awakening time. In group L, the median postoperative pain score was significantly lower at 4th hour (group L 5 (3, 6) vs. group N 6 (4, 8), p = 0.029). However, group L had higher incidence of hypotension (group L 84.4% vs. group N 68.7%, p = 0.037).

Conclusion: The scalp block with 0.5% levo-bupivacaine, added up to intravenous fentanyl and local infiltration, provided slightly better postoperative pain control for craniotomy.

Keywords: Scalp block, Craniotomy, Pain, Hypotension

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