A PROSPECTIVE, RANDOMIZED STUDY COMPARING THE ANALGESIC EFFICACY OF SCALP BLOCK WITH 0.25% BUPIVACAINE VS PRE-INCISIONAL LOCAL INFILTRATION WITH 0.25% BUPIVACAINE WITH ADRENALINE (1:400,000) IN PATIENTS UNDERGOING ELECTIVE CRANIOTOMIES

Background and Aims: Pain is often referred to as the fifth vital sign. Pain management in patients undergoing craniotomies pose a great challenge to the anaesthesiologists. Scalp block forms an important aspect in the multimodal approach to the post-craniotomy pain. The following study compares the analgesic efficacy of Scalp block with traditionally used local wound infiltration technique in providing analgesia to craniotomy patients.

Methods: Performed double blinded, prospective, randomized controlled trial on 60 patients undergoing elective craniotomies divided into 2 groups comparing  the analgesic efficacy of Scalp block with 0.25% Bupivacaine vs Pre- incisional wound infiltration with 0.25% Bupivacaine with Adrenaline (1:400,000).

Results:There were significant differences in intra-operative hemodynamics between the two groups. Scalp block  resulted in statistically significant reduction in HR, SBP, DBP & MAP. There was increased duration of post-operative analgesia in scalp block group when compared with the local infiltration group. The opioid requirement in the intra-operative period was  significantly  lesser in scalp block group when compared with the local infiltration group. Requirement of rescue analgesic is significantly  lesser during early post-operative period (Upto 8 hours) in the scalp block group when compared with local infiltration group.

Conclusion :Scalp block with 0.25% Bupivacaine is effective and superior to Pre-incisional Local infiltration with 0.25% Bupivacaine with 1:400,000 Adrenaline in attenuating hemodynamic responses, providing increased duration of post-operative analgesia, significant  reduction in intra-operative opioids and post-operative rescue analgesic requirements.