Comparison of sterile silicone studs and scalp infiltration with lignocaine for the attenuation of the hemodynamic and stress response to skull pin insertion during craniotomy in pediatric neurosurgical patients: a randomized controlled trial : Sterile silicone studs versus lignocaine infiltration for skull pin insertion.

In 30 seconds

This randomized controlled trial compared sterile silicone studs (SSS) with lignocaine infiltration for skull pin insertion in 64 children aged 12 years or younger undergoing neurosurgery. Compared with lignocaine, SSS was associated with lower rescue fentanyl consumption (10.3 ± 7.5 µg vs. 18.5 ± 8.6 µg; P < 0.001) and fewer children requiring rescue analgesia (65.6% vs. 90.6%). Heart rate and mean arterial pressure were also higher with lignocaine at pin insertion and through 10 minutes afterward. Minor pin-site bleeding was more frequent with lignocaine, and surgeon satisfaction was higher with SSS.

Key findings

• Rescue fentanyl consumption was 10.3 ± 7.5 µg with SSS versus 18.5 ± 8.6 µg with lignocaine (P < 0.001).
• Rescue analgesia was required by 65.6% of the SSS group and 90.6% of the lignocaine group.
• Heart rate and mean arterial pressure were higher with lignocaine at pin insertion and up to 10 minutes afterward.
• Minor pin-site bleeding was more frequent with lignocaine; surgeon satisfaction was higher with SSS.

Why it matters

Skull pin insertion can provoke nociceptive and sympathetic responses in children undergoing neurosurgery. In this trial, SSS was associated with lower opioid rescue use and less hemodynamic response than lignocaine infiltration, making it a potentially useful non-pharmacological approach to study further. The findings are relevant to perioperative analgesia and hemodynamic management, but do not establish safety conclusively.

What to keep in mind

The trial included 64 children, and the authors state that larger multicenter trials are needed to establish SSS safety conclusively.