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Effect of scalp block with 0.5% ropivacaine on interleukin-6 and neutrophil lymphocyte ratio in elective craniotomy

  • Pricilia Desiree ,
  • Prananda Surya Airlangga ,
  • Prihatma Kriswidyatomo ,
  • Christrijogo Soemartono Waloejo ,
  • Hamzah ,
  • Dhania A. Santosa ,
  • Bambang Pujo Semedi ,
  • Dedi Susila ,
  • Noor Syamsu Komarulloh ,
  • Ovi Octavia Karamoy ,
  • Pudji Lestari ,
  • Moses Glorino Rumambo Pandi ,

Abstract

Background: In recent decades, the study of immunology has evolved rapidly, elucidating the cellular and molecular mechanisms underlying human immunity. Recent studies have shown that high levels of cytokines correlate with the degree of manipulation of brain tissue and lower levels of inflammation in brain tumor surgery are associated with higher safety rates. The use of scalp block in craniotomy surgery is associated with the modulating effect of both local and systemic inflammatory responses. This study aims to analyze the effect of scalp block with 0.5% ropivacaine on IL-6 and NLR in elective craniotomy surgery.

Method: A randomized controlled trial (RCT) was conducted at Dr. Soetomo General Hospital Surabaya with a total of 40 patients who underwent elective craniotomy from September to November 2023. Patients were divided into two groups: the scalp block (SB) group and the non-scalp block (non-SB) group. All patients were under general anesthesia and a scalp block was added to the SB group after general anesthesia. IL-6 concentration and NLR count were assessed after general anesthesia (T0), 6 hours after incision (T1), and 24 hours after surgery (T2).

Results: IL-6 and NLR levels increased over time and reached their peak at 24 hours after surgery in both groups with IL-6 SB: 83.50 ± 2,289 pg/mL and IL-6 non-SB: 84,638 ± 2.25 pg/ml. NLR SB: 6.80 ± 1.17 and NLR non SB: 7.33 (5.83-8.09). In the comparative test, there was a significant difference in IL-6 and NLR levels at 6 hours after incision (p:<0.001 and p=0.0015), and significant differences in changes IL-6 baseline and 6 hours after incision (∆T0-T1)  (P:<0.001). However, there was no significant difference in IL-6 and NLR levels at 24 hours after surgery and no significant difference in the changes between IL-6 baseline and 24 hours after surgery (∆T0-T2), NLR baseline, and 6 hours after incision (∆T0-T1), NLR baseline and 24 hours after surgery (∆T0-T2) between two groups.

Conclusion: Scalp block suppresses pro-inflammatory mediators for only 6 hours after incision. It is most effectively used in short procedures, as an adjuvant for the head pinning procedure or incision.  

References

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How to Cite

Desiree, P., Airlangga, P. S. ., Kriswidyatomo, P. ., Waloejo, C. S. ., Hamzah, Santosa, D. A. ., Semedi, B. P. ., Susila, D. ., Komarulloh, N. S. ., Karamoy, O. O. ., Lestari, P. ., & Pandi, M. G. R. . (2024). Effect of scalp block with 0.5% ropivacaine on interleukin-6 and neutrophil lymphocyte ratio in elective craniotomy. Bali Medical Journal, 13(1), 668–674. https://doi.org/10.15562/bmj.v13i1.5194

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Pricilia Desiree
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Prananda Surya Airlangga
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Prihatma Kriswidyatomo
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Christrijogo Soemartono Waloejo
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Hamzah
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Dhania A. Santosa
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Bambang Pujo Semedi
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Dedi Susila
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Noor Syamsu Komarulloh
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Ovi Octavia Karamoy
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Pudji Lestari
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Moses Glorino Rumambo Pandi
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