Hemodynamic response to skull pins application in children: Effect of lignocaine infiltration of scalp

Background: Skull pins application following local anesthetic infiltration of scalp obtunds hemodynamic changes in adults. No such study is available in children. Methods: 30 children undergoing elective suboccipital craniectomy with skull pins fixation, were randomly allocated either to control group I, or lignocaine group II. Whereas in group I, pins were applied without any scalp infiltration. In group II, pins were applied 1 min. after scalp infiltration with 0.5% lignocaine (plain) at each pin site. Results: Mean arterial pressure and heart rate were recorded during pinning (peak increase),1,4,7 and 10 min later, and were compared with the baseline (parameters recorded approximately 20 min. after intubation). Mean arterial pressure in group I peaked from 77.0 ± 9.19 to 113.87 ± 13.7mmHg (P<0.001) and remained significantly high throughout the study period. In Group II peak increase in mean arterial pressure was from 91.64 ± 16.39 to 101.85 ± 15.87 mmHg (P<0.01) and remained high till 1 min. only. Pins placement resulted in significant increase in heart rate only during pinning (peak increase) and up to 1 min. in both the groups (P<0.01). Conclusions: In children, skull pins placement 1 min. after scalp infiltration with 0.5% lignocaine plain fails to prevent the hemodynamic changes arising during pins placement (peak change) and up to 1 min. after pins placement. However, the technique successfully blocks these changes beyond 1 min. post skull pins fixation.

Keywords
Neurosurgical anesthesia, Pediatric, Local anesthetic infiltration, Skull pin head-holder