Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study
Background and Aims: Skull pin application during craniotomy elicits haemodynamic responses that may be detrimental to the patient. This study evaluates and compares the effects of intravenous (IV) lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine on haemodynamic and stress response to sku...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-04-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_266_24 |
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| author | Swathi Mallikarjuna Rajnish Arora Anissa Mirza Sanjay Agrawal |
| author_facet | Swathi Mallikarjuna Rajnish Arora Anissa Mirza Sanjay Agrawal |
| author_sort | Swathi Mallikarjuna |
| collection | DOAJ |
| description | Background and Aims:
Skull pin application during craniotomy elicits haemodynamic responses that may be detrimental to the patient. This study evaluates and compares the effects of intravenous (IV) lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine on haemodynamic and stress response to skull pins.
Methods:
This randomised study was conducted on 160 patients aged 18–60 years. Patients for craniotomy with skull pin application were randomly assigned to receive IV lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h (Group L), dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group D), lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h and dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group LD), and normal saline bolus (15 min) followed by 5 mL/h (Group N) for 30 min after skull pin insertion. Haemodynamic variables (heart rate, mean arterial pressure, and bispectral index) and stress response (serum cortisol, prolactin, blood sugar, and neutrophil-lymphocyte ratio (NLR)) were observed at different periods. For group comparisons, a one-way analysis of variance was used for preoperative blood sugar, and the Kruskal-Wallis test was used for heart rate, blood pressure, bispectral index, serum cortisol, serum prolactin, and neutrophil-to-lymphocyte ratio (NLR).
Results:
Haemodynamic fluctuations were less in groups D and LD. Group LD had decreased levels of serum cortisol (P < 0.001), prolactin (P = 0.315), and NLR (P = 0.002). Blood sugar increased in all groups but was significant in groups N and D (P < 0.001).
Conclusion:
The dexmedetomidine-lignocaine infusion is associated with few haemodynamic fluctuations and decreased stress response compared to lignocaine or dexmedetomidine alone, hence better in attenuating skull pin response. |
| format | Article |
| id | doaj-art-753e00a22c3d455a868121507818946e |
| institution | OA Journals |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-753e00a22c3d455a868121507818946e2025-08-20T02:25:13ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-04-0169435035710.4103/ija.ija_266_24Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative studySwathi MallikarjunaRajnish AroraAnissa MirzaSanjay AgrawalBackground and Aims: Skull pin application during craniotomy elicits haemodynamic responses that may be detrimental to the patient. This study evaluates and compares the effects of intravenous (IV) lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine on haemodynamic and stress response to skull pins. Methods: This randomised study was conducted on 160 patients aged 18–60 years. Patients for craniotomy with skull pin application were randomly assigned to receive IV lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h (Group L), dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group D), lignocaine 2 mg/kg (15 min) followed by 1.5 mg/kg/h and dexmedetomidine 1 µg/kg (15 min) followed by 0.5 µg/kg/h (Group LD), and normal saline bolus (15 min) followed by 5 mL/h (Group N) for 30 min after skull pin insertion. Haemodynamic variables (heart rate, mean arterial pressure, and bispectral index) and stress response (serum cortisol, prolactin, blood sugar, and neutrophil-lymphocyte ratio (NLR)) were observed at different periods. For group comparisons, a one-way analysis of variance was used for preoperative blood sugar, and the Kruskal-Wallis test was used for heart rate, blood pressure, bispectral index, serum cortisol, serum prolactin, and neutrophil-to-lymphocyte ratio (NLR). Results: Haemodynamic fluctuations were less in groups D and LD. Group LD had decreased levels of serum cortisol (P < 0.001), prolactin (P = 0.315), and NLR (P = 0.002). Blood sugar increased in all groups but was significant in groups N and D (P < 0.001). Conclusion: The dexmedetomidine-lignocaine infusion is associated with few haemodynamic fluctuations and decreased stress response compared to lignocaine or dexmedetomidine alone, hence better in attenuating skull pin response.https://journals.lww.com/10.4103/ija.ija_266_24craniotomydexmedetomidinehaemodynamicslidocainelignocainepainskull pin neurosurgerystress response |
| spellingShingle | Swathi Mallikarjuna Rajnish Arora Anissa Mirza Sanjay Agrawal Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study Indian Journal of Anaesthesia craniotomy dexmedetomidine haemodynamics lidocaine lignocaine pain skull pin neurosurgery stress response |
| title | Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study |
| title_full | Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study |
| title_fullStr | Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study |
| title_full_unstemmed | Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study |
| title_short | Comparison of intravenous lignocaine, dexmedetomidine, and lignocaine-dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours: A placebo-controlled, double-blinded, randomised comparative study |
| title_sort | comparison of intravenous lignocaine dexmedetomidine and lignocaine dexmedetomidine infusion for attenuation of pain response to skull pin application in patients of intracranial tumours a placebo controlled double blinded randomised comparative study |
| topic | craniotomy dexmedetomidine haemodynamics lidocaine lignocaine pain skull pin neurosurgery stress response |
| url | https://journals.lww.com/10.4103/ija.ija_266_24 |
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