title: Impact of subcutaneous infiltration of 0.5% bupivacaine on post-operative C-reactive protein serum titer after craniotomy surgery.
abstract: BACKGROUND
  Tissue injuries may provoke neuro-hormonal response which in turn may lead to release of inflammatory cytokines. We hypothesize that block of afferent sensory pathways by infiltration of 0.5% bupivacaine in the scalp may decrease neuro-hormonal response in the neurosurgical patient.
  
  
  METHODS
  After obtaining informed consent, forty ASA physical statuses I, II, or III patients between the ages of 18 and 65 years were enrolled randomly into two equal groups to receive either 20 ml of 0.5% bupivacaine (group A) or 20 ml of 0.9% normal saline as a placebo (group B) in the site of pin insertion and scalp incision. As the primary outcome we checked serum C-reactive protein (CRP) levels before implementation of noxious stimulus, 24h, and 48h after the end of surgery to compare these values between groups. In addition, mean arterial pressure (MAP) and heart rate (HR) were checked at baseline (after the induction of anesthesia), one minute after pin fixation and 5, 10, and 15 minute after skin incision and the recorded values were compared between groups.
  
  
  RESULTS
  No significant difference was found between serum CRP levels of the two groups. Comparison of mean HR between groups shows no significant difference. The mean of MAP was significantly lower in the group A in comparison with the group B (p< 0.001).
  
  
  CONCLUSIONS
  The results of this study confirm that 0.5% bupivacaine scalp infiltration before skull-pin holder fixation and skin incision could not decrease post-operative C-reactive protein level.
authors.affiliation: Associate Professor of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran. moharari@tums.ac.ir.
authors.forename: Reza Shariat
authors.initials: RS
authors.lastname: Moharari
authors.forename: Saber Amin
authors.initials: SA
authors.lastname: Zade
authors.forename: Farhad
authors.initials: F
authors.lastname: Etezadi
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Khajavi
authors.forename: Mohammad Shirani
authors.initials: MS
authors.lastname: Bidabadi
authors.forename: Hadieh Moradi
authors.initials: HM
authors.lastname: Tabriz
keywords: C-reactive protein; Craniotomy; Inflammatory response; Neuro-hormonal response