Hemodynamic outcomes of adult patients on scalp block using ropivacaine and lidocaine: retrospective cohort study
Sheryl Lucille Alcibar-Abrenica,1 Eugene Lee Barinaga1
1Department of Anesthesiology, Southern Philippines Medical Center, JP Laurel Ave, Bajada, Davao City, Philippines
2Davao Medical School Foundation Hospital, Medical School Drive, Bajada, Davao City, Philippines
3Ricardo Limso Medical Center, Ilustre St, Poblacion District, Davao City, Philippines
4Brokenshire Integrated Health Ministries Inc, Brokenshire Heights, Madapo, Davao City, Philippines
5Metro Davao Medical & Research Center Inc, JP Laurel Ave, Davao City, Philippines
6Department of Anesthesiology, San Pedro Hospital of Davao City Inc, C Guzman St, Davao City, Philippines
7Community Health and Development Cooperative Hospital, Anda Riverside, Davao City, Philippines
8Department of Anesthesiology, Davao Doctors Hospital, E Quirino Avenue, Davao City, Philippines
9Tebow Cure Hospital, JP Laurel Ave, Davao City, Philippines
Correspondence Sheryl Lucille Alcibar-Abrenica, email@example.com
Article editors Dahlia Arancel, Jessy Mae Panggoy
Received 5 July 2017
Accepted 8 September 2017
Cite as Alcibar-Abrenica SL, Barinaga EL. Hemodynamic outcomes of adult patients on scalp block using ropivacaine and lidocaine: retrospective cohort study. SPMC J Health Care Serv. 2017;3(2):7. http://n2t.net/ark:/76951/jhcs9cce49
Background. Hemodynamic instability can occur with the pain from scalp incision to brain retraction during cranial neurosurgery.
Objective. To determine the hemodynamic outcomes of patients who received ropivacaine plus lidocaine scalp block.
Design. Retrospective cohort study.
Setting. Southern Philippines Medical Center, Davao City.
Participants. 44 patients given scalp block for cranial neurosurgery.
Main outcome measures. Heart rate (HR), mean arterial pressure (MAP), and frequencies of tachycardia, hypertension, bradycardia, and hypotension from the time of scalp block administration to 15 minutes after scalp incision (observation period).
Main results. There were 31 (70.45%) male and 13 (20.55%) female patients in this study. The patients’ mean age was 42.97 ± 17.33 years. Mean values of MAP from 5 minutes before incision to 15 minutes after incision all significantly differed from mean baseline MAP. There were no significant changes in mean HR within the observation period (p=0.2446). Among the patients, 3/44 (6.82%) had at least one episode of hypertension, 7/44 (15.91%) had at least one episode of tachycardia, 8/44 (18.18%) had at least one episode of bradycardia, and 27/44 (61.36%) had at least one episode of hypotension during the observation period.
Conclusion. The mean MAP of patients in this study significantly decreased from baseline starting from 5 minutes prior to scalp incision to 15 minutes after scalp incision. Many patients had at least one episode of hypotension, while fewer patients experienced at least one episode of hypertension, tachycardia or bradycardia.
Keywords. cranial neurosurgery, heart rate, mean arterial pressure, scalp incision
Table 1 Demographic and clinical profile of patients
|Mean age ± SD, years||42.97 ± 17.33|
|Indication for neurosurgery, frequency (%) n=43|
|Blunt head trauma||24 (55.81)|
|Brain tumor||9 (20.93)|
|Cerebrovascular accident||7 (16.28)|
|Gunshot wound||2 (4.65)|
|ASA classification, frequency(%)|
|ASA II||25 (56.82)|
|ASA III||13 (29.55)|
|ASA IV||5 (11.36)|
|ASA V||1 (2.27)|
|Mean GCS score ± SD||12 ± 3|
ASA—American Society of Anesthesiologists; GCS—Glasgow Coma Scale.
Table 2 Mean systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate across time
|Mean systolic blood pressure ± SD, mmHg||137.32 ± 26.45||113.30 ± 24.05||111.02 ± 21.82||110.07 ± 19.72||107.52 ± 20.29||104.07 ± 17.30||<0.0001|
|Mean diastolic blood pressure ± SD, mmHg||76.80 ± 16.06||62.86 ± 15.07||61.09 ± 14.80||61.18 ± 14.78||58.72 ± 12.76||57.36 ± 12.76||<0.0001|
|Mean mean arterial pressure ± SD, mmHg||96.97 ± 18.46||79.67 ± 17.26||77.73 ± 16.49||77.48 ± 15.57||74.99 ± 14.64||72.93 ± 13.37||<0.0001|
|Mean heart rate ± SD, beats per minute||89.07 ± 25.01||83.32 ± 21.58||82.05 ± 21.35||80.69 ± 21.34||78.68 ± 20.27||78.82 ± 22.45||0.2446|
Baseline—at the time of scalp block administration; 5BI—5 min before scalp incision; UI—upon scalp incision; 5AI—5 min after incision; 10AI—10 min after incision; 15AI—15 min after incision.
Figure 1 Systolic (A) and diastolic (B) blood pressures, mean arterial pressure (MAP; C), and heart rate (D) graphs of patients who underwent cranial neurosurgery at the time of scalp block administration (Baseline), 5 minutes before incision (5BI), upon incision (UI), 5 minutes after incision (5AI), 10 minutes after incision (10AI), and 15 minutes after incision (15AI).
Table 3 Demographic and clinical profile of patients
|Bradycardia, frequency(%)||8 (18.18)|
|Tachycardia, frequency(%)||7 (15.91)|
|Hypotension, frequency(%)||27 (61.36)|
|Hypertension, frequency(%)||3 (6.82)|
*At least one episode from scalp block administration to 15 minutes after scalp incision.
We would like to thank Dr Ana Maria Karla Datiles-Lei for sharing to us her expertise on the use of scalp block during cranial neurosurgery. We would also like to extend our gratitude to Dr Anna Lorraine Sison and Dr Manuel Gonzaga for their inputs during the writing of this report, and to Mr Jay Lord Canag for his assitance in preparing the statistics portion of this report.
This study was reviewed and approved by the Department of Health XI Cluster Ethics Review Committee (DOH XI CERC reference P16030901).
Reporting guideline used
Supported by personal funds of the authors
Access and license
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