A Clinical Observation:the Effect Of Regional Scalp Block On Plasma Endothelin In Craniotomy Patients

Objectives:The postoperative pain of craniotomy can cause a variety of hormones and cytokines released,meanwhile,then influence the process of recovery of central nervous system,the pain can make endothelial cells synthesize and releas the plasma endothelin (ET), it is a kind of strong shrink blood vessels material, not only can lead to cerebral ischemia, hypoxia caused by shrink cerebrovascular,also can promote brain tissue release of excitatory amino acids, promote calcium ion inward flows and oxygen free radical- generation, so as to exacerbation the damage of brain tissue;Severe high blood pressure,heart rate increase fast on intracranial,pressure and the patients of brain aneurysm are harmful, therefore it was important that prevention of the increase of blood pressure caused by different kinds of intense stimulation.The objectives of this study were to observe the effect of scalp nerve block on plasma endothelin in craniotomy patients、the postoperation pain、the value change tendency of when the skin incision and the process of extubation.Methods:Select 60 selective craniotomy patients, ASA Ⅰ～Ⅱ grade.Divided them into two groups randomly and averagely, regional scalp block group(group-R) and normal saline(NS) control group (group-C).Execute regional scalp block in group-R with local anaesthetics,Execute regional scalp block in rroup-C with NS, then give two group the same general anesthesia.Draw venous blood 1.5 ml from two groups of patients at preoperative and postoperative 2、6、12 hour,then determination of plasma endothelin levels.Record the viual analogue scale score(VAS) at postoperative 2,6,12 hour.Record the HR,MAP value before fix operating racks、fix operating racks and after skin incision.Record the required time to extubation.Results:Compared two groups of patients, the gender, age, weight, operation time,the results had no significant statistical difference.The two groups of plasma endothelin levels measured in Preoperative,the data had no statistical difference; The plasma endothelin level of group-R was lower than that in group-C in 2,6,12 h after craniotomy,the result was statistically significant (P< 0.05).The pain visual analogue scale (VAS) of group R lower than that of group C in 2,6,12h after craniotomy was statistically significant (P< 0.05).The value of HR, MAP before fix operating rackson no statistical difference; the value of HR, MAP of Group-C increases obviously when fix operating racks、skin incision,the results were statistically significant (P< 0.05).The required time to extubation of group R lower than that of group C,the result was statistically significant (P< 0.05).Compared the Postoperative Complications two groups,the results had no significant difference.Conclusion(s):1.The preoperative performace of scalp nerve block can significantly reduce the postoperative plasma endothelin levels in neurosurgery patients.2,The preoperative performace of scalp nerve block can significantly reduce thePostoperative pain, improve patient ’comfortable sensation.3, The preoperative performace of scalp nerve block can significantly reduce hemodynamic fluctuations when skin incision.4.The preoperative performace of scalp nerve block can significantly reduce the required time to extubation.