title: A prospective, comparative, randomised, double blind study on the efficacy of addition of clonidine to 0.25% bupivacaine in scalp block for supratentorial craniotomies.
abstract: OBJECTIVE
  Scalp blocks combined with general anaesthesia reduce pin and incision response, along with providing stable perioperative haemodynamics and analgesia. Clonidine has proved to be a valuable additive in infiltrative blocks. We studied the efficacy and safety of addition of clonidine 2 μg/kg to scalp block with 0.25% bupivacaine (Group B) versus plain 0.25% bupivacaine (Group A) for supratentorial craniotomies.
  
  
  METHODS
  Sixty patients were randomly divided into two groups to receive scalp block: Group A (with 0.25% bupivacaine) and Group B (with 0.25% bupivacaine and clonidine (2 μg/kg). Bilateral scalp block was given immediately after induction. All the patients received propofol based general anaesthesia. Intraoperatively, propofol infusion was maintained at 75 to 100 μg/kg/h up to dura closure and reduced to 50-75 μg/kg/h up to skin closure with atracurium infusion stopped at dura closure. Heart rate (HR) and mean arterial pressure (MAP) were monitored at pin insertion, at 5 minute intervals from incision till dura opening and again at 5 minute interval from dura closure up to skin closure. Fentanyl 0.5 μg/kg was given if a 20% increase in either HR and/or MAP was observed. Postoperative haemodynamics and verbal rating scores (VRS) were recorded. When the VRS score increased above 3, rescue analgesia was given. Any intraoperative haemodynamic complications were noted.
  
  
  RESULTS
  Group A showed a significant increase in haemodynamic variables during the perioperative period as compared to group B (P < 0.05). Addition of clonidine 2 μg/kg in the infiltrative block also provided significantly prolonged postoperative analgesia.
  
  
  CONCLUSIONS
  Addition of clonidine to scalp block provided better perioperative haemodynamic stability and significantly prolonged analgesia.
authors.affiliation: Department of Anaesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Anjana Sagar
authors.initials: AS
authors.lastname: Wajekar
authors.affiliation: Department of Anaesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Shrikanta P
authors.initials: SP
authors.lastname: Oak
authors.affiliation: Department of Anaesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Anita N
authors.initials: AN
authors.lastname: Shetty
authors.affiliation: Department of Anaesthesiology, Seth GSMC and KEM Hospital, Mumbai, Maharashtra, India.
authors.forename: Ruchi A
authors.initials: RA
authors.lastname: Jain
keywords: Analgesia; bupivacaine; clonidine; scalp block.