Comparison General Anesthesia And Combined Scalp Block With Ropivacaine 0.5% On Mean Arterial Pressure, Heartrate And Fentanyl Consumption During Craniotomy.

Rudi Iskandar Suryadani, Hamzah Hamzah, Nancy Margarita Rehatta, Arie Utariani


Surgical craniotomy such as skin incisions, head pinning, periosteal-dural contact, dura closure, bones and skin can cause of nociceptive stimulation. These actions are stimuli to the nerves that can stimulate stress response. The stress response to surgery is characterized by increased secretion of the pituitary hormone and activation of the sympathetic nervous system. Hypothalamic activation of the sympathetic autonomic nervous system results in increased secretion of catecholamines from the adrenal medulla and the release of norepinephrine from the presynaptic nerve terminal. Objectives: This study is a single blind experimental, 14 patients with ages 18-60 years physical status ASA (American Society of Anesthesiologists) 1-3, with elective craniotomy surgery. This study was divided into two groups of subjects, group A with seven craniotomy subjects with general anesthesia and group B with seven craniotomy subjects combined with scalp block using ropivacaine 0.5%. Data collected then analyzed with SPSS. We found a decrease in MAP (Mean Arterial Pressure) and heart rate in the scalp block group during scalp incision (MAP p=0.002; HR p=0.029), periosteal contact (MAP p=0.025; HR p=0.039) significantly, as well as the use of fentanyl during surgery was significantly decreased (p=0.0001). General anesthesia with scalp block is more effective in reducing the increase in MAP, heart rate and fentanyl consumption during craniotomy.

Save to Mendeley


Craniotomy, fentanyl, heart Rate, MAP, scalp block

Full Text:



Akcil E. F. et al. 2017. Which one is more effective work corrections required for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clinical Neurology and Neurosurgery; 154:98-103

Brydges G. et al. 2012. Awake Craniotomy: A Practice Overview. AANA Journal Course. Vol.80, No.1:61-68

Cormack J. and Timothy F. 2005. Awake Craniotomy: Anaesthetic Guidelines and Recent Advances. Australasian Anaesthesia. 77-83

Desborough J. 2000. The stress response to trauma and surgery. British journal of anaesthesia; 85:109-17

Flood P., Rathmell J.P., and Shafer, S. 2015. Stoelting's Pharmacology & Physiology in Anesthetic Practice. 5th Ed. United States of America: Wolters Kluwer Health. Part II: 46-95.

Gunadi M. and Suwarman. 2013. Scalp Nerve Block pada Kraniotomi Evakuasi Pasien Moderate Head Injury Dengan Subdural Hemorrhage dan Intracerebral Hemorrhage Frontotemporoparietal Dekstra Mencegah Stress Response Selama dan Pascabedah. Jurnal Anestesi Perioperatif; 1(3):197

Kuthiala G. and Chaudhany G. 2011. Review article, Ropivacain: A review of its pharmacology and clinical use. Indian journal of anesthesia. Vol. 55.

Lee E.J., Lee M.Y., Shyr M.H. 2006. Adjuvant bupivacaine scalp block facilitates stabilization of hemodynamics in patients undergoing craniotomy with general anesthesia: a preliminary report. J Clin Anesth;18:490–494

Lyons J.P. et al. 2015. Fentanyl-induced Hyperalgesia in Acute Pain Management. Journal of Pain & Palliative Care Pharmacotherapy:29;153-160

Markovic B.J., Karpe B., Potocnik I., Jerin A., Vranic A., Novak-Jankovic V. 2016. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiology;16(18):1-8.

New York School of Regional Anesthesia. 2019. Nerve Blocks of the Face. Access from:

Osborn I. and Sebeo J. 2010. “scalp block “During Craniotomy: A classic technique Revisited. J Neurosurg Anesthesiol;22;187-194

Solihat, Y. 2013. Opioid In Balanced Anesthesia for Emergency Craniotomy with Meningioma. Jurnal Anestesiologi Indonesia. Vol. V No.2

Stoelting R.K. 1999. Pharmacology and Physiology in Anesthetic Practice 3 ed. New York: Lippincott-Raven; Chapter 3: 77-112 and Chapter 6: 148- 154

Takdir M. 2009. Anestesia Lokal. Panduan Tatalaksana Nyeri Perioperatif. Perhimpunan Dokter Spesialis Anestesiologi dan Reanimasi Indonesia; 67-85

Theerth K. et al. 2018. Analgesia Nociception Index-guided intraoperative fentanyl consumption and postoperative analgesia in patients receiving scalp block versus incision-site infiltration for craniotomy. Edizion Minerva medica; 84(12):1361-8

Tonkovic D. et al. 2015. Scalp block for hemodynamic stability during neurosurgery. Periodicum biologorum. 2015: Vol 117, No 2, 247-250

Tuchida L, Somboonviboon, et al. 2010. Bupivacaine scalp nerve block: hemodynamic response during craniotomy, intraoperative and postoperative analgesia. Asian Biomedicine; 4:243-251

Wahyuhadi J., Suryaningtyas W., et al. 2014. Pedoman tatalaksana cedera otak. RSUD dr. Soetomo fakultas kedokteran Universitas Airlangga; 2:1

Wall and Melzack. 2013. Textbook of pain. Elsavier saunders. Philadelphia. 2013;14-180

Vacas S. and Van de Wiele B. 2017. Designing a pain management protocol for craniotomy: A narrative review and consideration of promising practices. Surgical Neurology International; 8:291