Ropivacaine vs Levobupivacaine Scalp BlockIntraoperative Hemodynamic Stability and Requirement of Additional Analgesia in Supratentorial Craniotomy, a Comparative Study

Background: Neuroanaesthesia is very challenging as maintaining good haemodynamic stability intraoperatively is important.Scalp block can be an effective measure in providing good peri-operative haemodynamic stability and favourable postoperative neurological profile for assessment.Aim: To compare the efficacy of isobaric 0.5% Ropivacaine with isobaric 0.5% Levobupivacaine when used for scalp block in terms of intraoperative haemodynamic stability and requirement of additional analgesia and anaesthetics intraoperatively.Methods: 60 patients of either sex, aged between 18 to 60 years, ASA grade I and II undergoing elective supratentorial craniotomy under General Anaesthesia (GA) were randomly divided into 2 groups.Group B was given scalp block with isobaric 0.5% Levobupivacaine whereas Group R with isobaric 0.5% Ropivacaine.Scalp block was performed after standard GA induction using Modified Pinosky technique.Intraoperative surges in heart rate (HR) or systolic blood pressure (SBP) were noted in response to skull pin insertion and scalp incision.Overall haemodynamic stability and total requirement of additional analgesia and anaesthetics intraoperatively were noted.Results: The response to pin insertion was obtunded by both Ropivacaine and Levobupivacaine but overall, the response to pin insertion concerning mean HR was better in Group B than Group R. The response to incision was blunted in both the groups but was better in Group R. The requirement of additional analgesia and anaesthetic was higher in Group R than Group B and therefore, hemodynamic stability also appears to be better in Group R.Conclusion: Ropivacaine and Levobupivacaine (20 ml of isobaric 0.5% conc.) when used for scalp block, were both effective in preventing sympathetic response to skull pin insertion and incision.However, overall Levobupivacaine has better efficacy.