Ketamine Versus Dexmedetomidine as an Adjuvant in Scalp Block in Supratentorial Brain Tumor Excision Surgeries

Supratentorial brain tumor surgeries are associated with significant nociceptive stimulation and postoperative pain, which may adversely affect patient outcomes. Scalp block has emerged as an effective regional anesthetic technique to improve analgesia and reduce opioid consumption. Objective: To compare efficacy of ketamine versus dexmedetomidine as adjuvants to bupivacaine in scalp blocks for supratentorial brain tumor surgeries, focusing on analgesia, opioid consumption, and hemodynamic stability. Methods: This randomized double-blinded controlled trial included 80 patients undergoing supratentorial tumor excision, allocated equally into two groups: Group K received bupivacaine with ketamine (2 mg/kg), and Group D received bupivacaine with dexmedetomidine (1 µg/kg). Intraoperative hemodynamics, fentanyl consumption, postoperative pain scores (NRS), analgesic requirements, and complications were assessed.

Inclusion Criteria: * Age from 20 to 60 years, both sexes, American Society of Anesthesiologists (ASA) physical status II-III, Supratentorial tumor excision, Supine Position. and operation time: less than 6 hours. Exclusion Criteria: * Patient refusal, disturbed consciousness level (Glasgow Coma Scale \[GCS\] \< 15). Patients who required reintubation during the study period, those not extubated. immediately after surgery, or those who awoke with neurological deficits impairing. pain assessments were excluded from the final analysis, history of psychotic disorders or previous surgeries, Poor cognitive function. Postictal state or uncontrolled/recurrent seizures, known allergy to dexmedetomidine or ketamine, difficult intubation (Mallampati score \> III) or multiple intubation attempts, operation duration \> 6 hours, renal dysfunction (creatinine \> 1.2 mg/dL, BUN \> 20 mg/dL), heart block and patients with chronic headache disorders or those receiving chronic analgesic therapy (for \>3 months) were excluded.