• Tomohiro Chaki, Shigekazu Sugino, Piotr K Janicki, Yoshiya Ishioka, Yosuke Hatakeyama, Tomo Hayase, Miki Kaneuchi-Yamashita, Naonori Kohri, and Michiaki Yamakage.
• *Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo‡Department of Clinical Pharmaceutics, Hokkaido Pharmaceutical University School of Pharmacy, Otaru, Hokkaido, Japan†Department of Anesthesiology, Penn State Hershey Medical Center, Hershey, PA.
• J Neurosurg Anesthesiol. 2016 Jan 1; 28 (1): 1-5.

BackgroundMixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated.MethodsWe prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block.ResultsThe heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed.ConclusionsScalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

26 keywords...

hide…