Comparison of Scalp Block and Intravenous Esmolol for Hemodynamic Responses During Skull Pin Application in Elective Supratentorial Craniotomy

Background Skull pin application during craniotomy often causes significant hemodynamic responses that can be detrimental to patients with intracranial pathology. Both scalp block and intravenous esmolol are established methods for attenuating these responses, but their comparative efficacy remains unclear. The objective of this study was to compare the effectiveness of scalp block versus intravenous esmolol in controlling hemodynamic responses during skull pin application in patients undergoing elective supratentorial craniotomy. Methods This randomized controlled trial included 90 patients (ASA I‐II) scheduled for elective supratentorial craniotomy with skull pin application under general anesthesia. Patients were randomly allocated to receive either scalp block with local anesthetic (Group S, n = 45) or intravenous esmolol (Group E, n = 45). Primary outcomes included changes in mean arterial pressure (MAP), systolic blood pressure (SBP), heart rate (HR), and bispectral index (BIS) values at multiple time points around skull pin application. Secondary outcomes included postoperative morphine consumption and adverse events. Results Baseline demographics were comparable between groups. Group S demonstrated significantly lower MAP and SBP compared to Group E at all time points after skull pin application ( p < 0.001 and p = 0.046). HR was consistently lower in Group S measured intervals ( p < 0.001). BIS values remained comparable throughout the study period. Postoperative morphine consumption at 6 h was lower in Group S (2.9 ± 3.0 vs. 4.6 ± 3.3 mg, p = 0.009). No significant differences in adverse events were observed. Conclusions Scalp block provided superior hemodynamic stability compared to intravenous esmolol during skull pin application, with additional benefits of reduced early postoperative analgesic requirements and no increase in adverse events. Trail Registration: ClinicalTrails.gov.identifier: NCT06268275