الفهرس 
Scalp AnatomyOnly 14 pages are availabe for public view
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Abstract
There are no randomized controlled trails (RCTs) comparing Scalp Block and Subcutaneous Infiltration for Stereotactic Brain Biopsy.
Objectives: to compare scalp block and subcutaneous infiltration anesthesia in adult patient during the placement of a stereotactic head-frame and taking brain biopsy as regard: analgesic efficacy, hemodynamic changes, duration of local anesthetic, need of supplementary subcutaneous injections, need for postoperative analgesia and postoperative complications.
Method: 80 patients were included in the study, Patients were randomly assigned to one of two groups, randomization was done by alternation of patients; group A: (40) patients who have received subcutaneous infiltration anesthesia; group B: (40) patients who have received scalp nerve blocks the scalp block was performed 10 min before the pin head holder application.
Measurments and main results: the VAS that was measured: During frame fixation, after 5 minutes, after 10 minutes, after 15 minutes, after 30 minutes, during biopsy, postoperative after1 hour, 6 hours and12 hours. The comparison between group A and group B, shows statistical significant difference in all periods VAS was measured (p<0.001). Regarding changes in heart rate, there is no significant differences between the two groups in the following intervals: Before, During fixation after 5 minutes, after 10 minutes and after 15 minutes. But, there is statistically significant differences between the two groups in the following intervals after 30 minutes, during biopsy, postoperative 1 hour, postoperative 6 hours and postoperative 12 hours. With more heart rate changes occur at group A in comparison to B. As regard MAP there is statistically significant differences between the two groups after 30 minutes of frame fixation , during biopsy, postoperative 1 hour, postoperative 6 hours and postoperative 12 hours, as MAP lower in group B than group A, With more need for more local infiltration at group A than group B that was statistically significant p-value (<0.001). as regard need for postoperative analgesia there is highly statistically significant difference p- value (<0.001), more need in group A than group B, postoperative headache more with group A than group B (p-value= 0.008).
Conclusion: our study support that scalp block with 0.5% bupivacaine reduced pain and hemodynamic mainly heart rate and MAP response during the fixation of stereotaxy frame , the skin incision and biopsy intake it also decrease the need for more local infiltration comparing with the use of local subcutaneous infiltration. Moreover, the pain intensity was lower after scalp block in the early postoperative period with less incidence of headache in post-operative period also