Effect Of Ropivacaine Scalp Infiltration On The Earlier Postoperative Cognitive In Patients Undergoing Surgical Resection Of Epileptic Foci

Objective:Local anesthetics incision infiltration can block the peripheral nerve and central nerve conduction, can reduce the amount of intraoperative anesthetic craniotomy, and to inhibit the action of the stress response. To improve the prognosis of understand its clinical application value,the present study was designed to show the effects of scalp infiltration with0.5%Ropivacaine on the earlier postoperative cognitive function in patients undergoing highly selective surgical resection of epileptic fociMethods:40patients aged18-45years old undergoing highly selective surgical resection of epileptic foci, ASA Ⅰ-Ⅱ were randomly divded into2groups. The0.5%Ropivacaine group(group R) received a incision infiltration with0.5%Ropivacaine200mg(40ml) and the control group received saline with the same volume at the same time.Both of the two groups’operation method were highly selective surgical resection of epileptic foci. The style of anesthesia were general anesthesia. Two groups received midazolam0.05mg/kg, fentanyl3ug/kg, atracurium0.6mg/kg and propofol1mg/kg for induction. Maintenance of anesthesia:Fentanyl was given to50ug or100ug per bolus due to the pain intensified, fentanyl was given to a total of5～10ug/kg during the surgery. Propofol was continuous pumping to maintain anesthesia throughout the procedure.Atracurium was given according to the haemodynamics in order to maintain muscle relaxation. Dosage of anesthesia was adjusted according to hemodynamic index and BIS index to maintain blood pressure within±20%of the baseline, and ephedrine was added if blood pressure fell below20%of the baseline.Record the MAP、HR、blood glucose level、 serum cortisol at each specific time point. A series of neuropsychological tests were performed and scored1day before and7days after operation. Z-combined score method was applied to diagnosis of cognitive dysfunction. Patients had cognitive dysfunction when a Z-combined score above than1.96or at least two Z scores from individual tests.Results:1.There were no significant differences between both groups (p>0.05). In the aspects of basic situation on age,weight,sex,ASA degree and the time of operation.2.There was a significant change in cortisol which group R is lower than group C at10min after incision infiltration.3.The operative fentanyl requirements were significantly lower in Group R(0.74±0.13mg)than Group C(1.02±0.18mg)(P<0.05). The operative propofol requirements were significantly lower in Group R(543.28±176.53mg)than Group C(883.31±212.43mg)(P<0.05). Atracurium and Midazolam consumption were no significant difference.4.The incidence of postoperative cognitive dysfunction in group R was10%(2/20), in group C was30%(6/30). The incidence of postoperative cognitive dysfunction in group R was significantly lower than that of group C(P<0.05).Conclusion:1.The study showed that0.5%Ropivacaine could decrease the propofol, fentanyl consumption during highly selective surgical resection of epileptic foci.2.The incidence of postoperative cognitive dysfunction in patients when used in Selective Highly selective surgical resection of epileptic foci could reduced by using0.5%Ropivacaine scalp infiltration.Graph4,Table10,Feferences34...