Several drugs have been used to reduce the hemodynamic responses evoked by skull-pin head-holder application and skin incision in neurosurgery. This study evaluated the effects of ropivacaine infiltration on hemodynamics followed by the skull-pin head-holder application and the skin incision.

Sixty-six patients who had been scheduled for neurosurgery under general anesthesia were randomly divided into five groups. Saline or different concentrations of ropivacaine (0.1, 0.2, 0.5, 0.75%) were infiltrated into skull-pin head-holder insertion sites and the skin incision site. Systolic and diastolic blood pressure, and heart rate were measured just before skull-pin head-holder application and 30 sec, 1 min, 3 min, and 5 min after skull-pin head-holder application and skin incision. Changes in hemodynamics were compared.

The systolic blood pressure (SBP) significantly increased on 30 sec and 1 min after skull-pin head-holder application, and on 30 sec, 1 min, 3 min, and 5 min after skin incision in the saline group and in the 0.1% ropivacaine group, respectively. Increased SBP was attenuated by 0.75% ropivacaine over the entire observation period. Increased diastolic blood pressure was reduced by 0.5% and 0.75% of ropivacaine at all times. The heart rate significantly increased on 30 sec and 1 min after skull-pin head-holder application in the saline group and in the 0.1% group. This increased heart rate was suppressed by 0.2%, 0.5%, and 0.75% ropivacaine.

These results indicate that ropivacaine attenuates the hemodynamic responses evoked by skull-pin head-holder application or skin incision in craniotomy. Ropivacaine was most active at 0.75%.