Efficacy and safety of a lidocaine and ropivacaine mixture for scalp nerve block and local infiltration anesthesia in patients undergoing awake craniotomy

Tomohiro Chaki, Shigekazu Sugino, Piotr K. Janicki, Yoshiya Ishioka, Yosuke Hatakeyama, Tomo Hayase, Miki Kaneuchi-Yamashita, Naonori Kohri, Michiaki Yamakage

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)

Abstract

Background: Mixtures of various local anesthetics, such as lidocaine and ropivacaine, have been widely used. However, their efficacy and safety for scalp nerve blocks and local infiltration during awake craniotomy have not been fully elucidated. Methods: We prospectively investigated 53 patients who underwent awake craniotomy. Scalp block was performed for the blockade of the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves with a mixture containing equal volumes of 2% lidocaine and 0.75% ropivacaine, including 5 μg/mL of epinephrine. Infiltration anesthesia was applied at the site of skin incision using the same mixture. The study outcomes included changes in heart rate and blood pressure after head pinning and skin incision, and incidence of severe pain on emergence from anesthesia. Total doses and plasma concentrations of lidocaine and ropivacaine were measured at different time points after performing the block. Results: The heart rate and blood pressure after head pinning were marginally, but significantly, increased when compared with baseline values. There were no significant differences in heart rate and blood pressure before and after the skin incision. Nineteen percent of the patients (10/53) complained of incisional pain at emergence from anesthesia. The highest observed blood concentrations of lidocaine and ropivacaine were 1.9±0.9 and 1.1±0.4 μg/mL, respectively. No acute anesthetic toxicity symptom was observed. Conclusions: Scalp block with a mixture of lidocaine and ropivacaine seems to provide effective and safe anesthetic management in patients undergoing awake craniotomy.

Original languageEnglish
Pages (from-to)1-5
Number of pages5
JournalJournal of Neurosurgical Anesthesiology
Volume28
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1
Externally publishedYes

Keywords

  • awake craniotomy
  • lidocaine
  • local anesthetic toxicity
  • ropivacaine
  • scalp block

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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