The Effect of 0.5% Levo-Bupivacaine Scalp Block during Craniotomy: A Double-Blind Randomized Placebo Controlled Trial
Manee Raksakietisak MD1, Pajongjit Suwansukroad MD1, Taschan Uengkajornkul MD1, Pranee Rushatamukayanunt MD1
Affiliation : 1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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 (18 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 10 to 15 mL. Both groups also received pre-incisional local anesthetic
infiltration from neurosurgeons due to their routine practice (a mixture of 0.5% bupivacaine 10 mL and 1% lidocaine with
epinephrine 1: 200,000 10 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
