Effect of Lignocaine Infiltration versus Intravenous Dexmedetomidine on Haemodynamic Response during Skull Pin Holder Application for Craniotomy: A Prospective Interventional Study

Abstract

Introduction: The use of a skull pin holder during craniotomy is a painful procedure that induces haemodynamic changes. This may lead to raised intracranial pressure, brain bulging, or intracranial haemorrhage. Effectively managing these stress responses is very important, as they may increase morbidity and mortality in neurosurgical patients. Aim: To compare the effects of lignocaine infiltration and intravenous dexmedetomidine on the haemodynamic stress response to skull pin holder application during craniotomy. Materials and Methods: This prospective interventional study was conducted on 122 patients over a period from June 2020 to June 2021 in the Neurosurgery operation theatre of Government Medical College, Kozhikode, Kerala, India, a tertiary care teaching centre. Patients were divided into two groups: Group-L received 3 mL of 2% lignocaine with 1 in 200,000 adrenaline at each premarked pin site, while Group-D received intravenous dexmedetomidine at a dose of 0.5 mcg/kg over 10 minutes before the induction of general anaesthesia. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were recorded at baseline, after induction, post-intubation, pre-pin application and at intervals of 1, 2, 3, 4, 5, 10 and 15 minutes post pin application. Stata version 14.2 was used for data analysis. Statistical comparison between the groups was conducted using the independent t-test and Chi-square test. Results: There was no statistically significant difference in HR and blood pressure between the groups immediately after skull pin application. However, Group-D exhibited a significant reduction in HR at 10 and 15 minutes (p<0.001) post pin application compared to Group-L. Additionally, a statistically significant reduction in SBP, DBP and MAP was observed among the groups at 5, 10 and 15 minutes post pin application, with a greater reduction in Group-D. Conclusion: Intravenous dexmedetomidine at a dose of 0.5 mcg/kg was as effective as lignocaine infiltration at the premarked pin site in reducing the haemodynamic stress response to the application of the skull pin holder. Dexmedetomidine at this dosage also showed a greater reduction in HR and blood pressure after five minutes post pin application and did not require any additional pharmacological measures.

Keywords

• blood pressure
• intracranial pressure
• morbidity
• neurosurgery
• skull pin application