Does scalp block with general anesthesia in craniotomy affect the intraoperative course and outcome in geriatric patients?

Abstract

Background The noxious stimuli during supratentorial brain tumor resection in geriatric patients result in a vigorous hemodynamic response and stress response, which represents a challenge during anesthesia. Patients and methods A total of 80 patients were enrolled in the study. There were 43 male and 37 female patients undergoing elective supratentorial craniotomy. Patients were randomly assigned into two equal groups: group B patients had scalp block using bupivacaine (0.5%) and epinephrine (1 : 400 000) and group F patients received fentanyl 2 μg/kg (during maintenance of general anesthesia (GA)). Heart rate (HR), mean arterial pressure (MAP), plasma cortisol level, and intracranial pressure (ICP) were recorded at baseline (before induction of anesthesia), 1 min after intubation, 1 min after skin incision, 1 min after dural incision, 1 min after dural closure, 1 min after skin closure, and 1 min after extubation. ICP measurement ceased at dural incision. Time to recovery from anesthesia was also recorded. Results MAP, HR, and plasma cortisol level showed significant differences between groups, wherein group F had higher MAP, HR, and plasma cortisol level than group B. Group B had rapid recovery period. Conclusion Scalp block with 0.5% bupivacaine with adrenaline 1 : 400 000 can be used as an alternative to general anesthesia with fentanyl in preventing the increase in arterial blood pressure (ABP), HR, ICP, cerebral perfusion pressure (CPP), and cortisol level, and also it allows early extubation and assessment of conscious level.