COMPARISON OF PLAIN ROPIVACAINE WITH ROPIVACAINE PLUS DEXAMETHASONE IN SCALP NERVE BLOCKS IN PATIENTS UNDERGOING SUPRATENTORIAL CRANIOTOMY UNDER GENERAL ANAESTHESIA: A RANDOMISED CONTROL TRIAL

BACKGROUND Pain during intra-operative and post-operative period of intracranial surgery causes severe fluctuations in haemodynamics, which can be detrimental for patients with compromised intracranial compliance. With scalp block, the sensory nerve fibres from the scalp and pericranial areas by using local anaesthetics and various adjuvants can reduce total anaesthetic requirement enabling early recovery and also reducing post-operative analgesic requirements. AIM To compare the effects of adding Dexamethasone to Ropivacaine and comparing its efficacy with plain Ropivacaine in providing adequate analgesia and post-operative analgesia, time of emergence from anaesthesia as well as incidence of side effects. MATERIAL AND METHODS 180 adult patients posted for craniotomy were divided randomly into two groups, Group R and Group D. Patients of Group R received scalp block with 0.2% Ropivacaine plus saline and patients of Group D received scalp block with 0.2% Ropivacaine plus 8 mg Dexamethasone after induction. Significant elevation in heart rate, blood pressure intraoperatively, intraoperative analgesic requirements, VAS scores at 1, 4, 8, 12 and 24 hours postoperatively and incidence of post-operative complications if any were recorded. RESULTS There was no statistically significant difference between the mean duration of scalp nerve block in both the groups, intraoperative haemodynamic changes, intraoperative Fentanyl requirements or duration of postoperative analgesia. However, VAS scores were higher in the patients of Group R compared to Group D, but there was no significant difference in the dose of intravenous Fentanyl for postoperative pain relief. There was no significant difference in the incidence of PONV. Intraoperative hyperglycaemia was noted in 2 patients of Group D, but sugar levels normalised by the end of the surgery. CONCLUSION The addition of 8 mg Dexamethasone to 0.2% Ropivacaine in scalp nerve block after induction of general anaesthesia for patients undergoing supratentorial craniotomy for intracranial space occupying lesion does not prolong the duration compared to plain 0.2% Ropivacaine, nor does decreased intraoperative Fentanyl requirements. There was also no difference in the time of emergence from anaesthesia or incidence of PONV.