Comparison of intravenous labetalol and bupivacaine scalp block on the hemodynamic and entropy changes following skull pin application: A randomized, open label clinical trial

Sidhesh Bharne, Prasanna Udupi Bidkar, Ashok Shankar Badhe, Satyen Parida, Andi Sadayandi Ramesh, Sidhesh Bharne, Prasanna Udupi Bidkar, Ashok Shankar Badhe, Satyen Parida, Andi Sadayandi Ramesh

Abstract

Background: The application of skull pins in neurosurgical procedures is a highly noxious stimulus that causes hemodynamic changes and a rise in spectral entropy levels. We designed a study to compare intravenous (IV) labetalol and bupivacaine scalp block in blunting these changes.

Patients and methods: Sixty-six patients undergoing elective neurosurgical procedures were randomized into two groups, L (labetalol) and B (bupivacaine) of 33 each. After a standard induction sequence using fentanyl, propofol and vecuronium, patients were intubated. Baseline hemodynamic parameters and entropy levels were noted. Five minutes before, application of the pins, group L patients received IV labetalol 0.25 mg/kg and group B patients received scalp block with 30 ml of 0.25% bupivacaine. Following application of the pins, heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and response entropy (RE)/state entropy (SE) were noted at regular time points up to 5 min.

Results: The two groups were comparable with respect to their demographic characteristics. Baseline hemodynamic parameters and entropy levels were also similar. After pinning, the HR, SAP, DAP, MAP, and RE/SE all increased in both groups but were lower in the scalp block group patients. HR increased by 19.8% in group L and by 11% in group B. SAP increased by 11.9% in group L and remained unchanged in group B. DAP increased by 19.7% in group L and by 9.9% in group B, MAP increased by 15.6% in group L and 5% in group B (P < 0.05). No adverse effects were noted.

Conclusion: Scalp block with bupivacaine is more effective than IV labetalol in attenuating the rise in hemodynamic parameters and entropy changes following skull pin application.

Keywords: Entropy; labetalol; scalp block; skull pins.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
CONSORT figure representing enrollment data
Figure 2
Figure 2
Changes in heart rate in two groups. *P<0.05
Figure 3
Figure 3
Changes in mean arterial pressure in two groups. *P<0.05
Figure 4
Figure 4
Response entropy changes in the two groups. *P<0.05
Figure 5
Figure 5
State entropy changes in two groups. *P<0.05

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