Skull pins and scalp incision infilteration with Bupivacaine Hydrochloride and Tramadol hydrochloride -- effects on the haemodynamic response in craniotomy under general anesthesia

Aim:-To evaluate the effect of Bupivacaine hydrochloride (0.25%) and Tramadol hydrochloride 1mg/kg in skull pin and scalp incision infiltration on haemodynamic response. Method:-120 patients planned for elective craniotomy were chosen and randomly divided in 3 equal groups. Skull pin site and scalp incision infiltration was done after 10 minutes of general anesthesia induction. In Group S patients, scalp infilteration was done with saline, Group B patients received 0.25% Bupivacaine and Group T patients received Tramadol 1mg/kg. Craniotomy frame pins were inserted 10 minutes after the infiltration. Pulse, systolic and diastolic BP was recorded as follows: 5 minutes before induction of GA (V1), 2 minutes after endotracheal intubation, 2 minutes before and after scalp infiltration, 2 minutes after scalp incision (V2), 2 minutes after scalp flap reflection, 2 minutes after bone flap removal (V3), 2 minutes after dural incision (V4). Result: - At V2, haemodynamic parameters were significantly higher (p<0.05) in Group S compared to Group B and Group T. In Group S, 18 patients (45%) required additional thiopenton sodium and more isoflurane dial concentration to control haemodynamic parameters and 3 patients needed Esmolol to control pulse rate. One patient in the Group B and 2 patients in Group T required such treatment. 39 (98%) patients in Group B and in Group T 39(98%) had satisfactory brain relaxation compared to Group S 22(55%) Conclusion: - Scalp incision and pin site infiltration with Bupivacaine or Tramadol provides stable haemodynamic parameters and intraoperative satisfactory brain relaxation. However no advantage was found of Tramadol over Bupivacaine