The Effect of Intravenous Fentanyl and Bupivacaine Infiltration on the Hemodynamic Respons During Mayfield Skull Clamps Fixation in Neurosurgery

Background: The aim of our study was to compare the effects of three techniques for preventing the hypertensive response to the insertion of Mayfield skull pins (MSP): group F (fentanyl), group B (bupivacaine) and FB (combined fentanylbupivacaine). Material and Methods: A hundred and eight patients scheduled to undergo craniotomy were randomly divided into three groups. Patients whose conditions of their current medication that might affect the stability of hemodynamic were excluded. Gr. F (n=36) received 2 mcg/kg fentanyl i.v. 5 min. before placement of MSP, group B (n=36) after induction the skin areas for the each pin were infiltrated with 3ml 0.5% bupivacaine. After an interval of 3 min the pins were inserted. In gr FB (n=36) both methods were applied together. All patients were given a TIVA with propofol and fentanyl. Blood pressure and heart rate-HR were recorded at five preset times: 1. after induction 2. at the onset of local anaesthesia 3. at the insertion of pin holder 4. 120 sec. and 5.240 sec after insertion. The measurements were compared with the immediate pre insertion values. Conclusion: Our results suggest that a significant reduction of the hemodynamic effects caused by insertion of the MSP can be achieved by the use of combined intravenous fentanyl and bupivacaine infiltration. Total TIVA alone with propofol and fentanyl cannot protect against these hemodynamic stimuli.