Comparing the bleeding control effect of labetalol, remifentanil and dexmedetomidine during craniotomy; A randomised clinical trial

Introduction: Blood loss management in craniotomy is essential for a patient's haemodynamic stability and a significantly better view of the surgical site. The study aimed to address the comparative efficacy of labetalol (LAB), remifentanil (REM) and dexmedetomidine (DXM) on the bleeding control during the craniotomy procedure. Materials and Methods: In a double-blind trial, ninety patients eligible for undergoing craniotomy were recruited and assigned to DXM, LAB and REM groups by the block-randomised method. The vital signs, including heart rate (HR), mean arterial pressure, and oxygen saturation (SaO2) after induction and during the hypotension phase every 15 min until the end of surgery and at recovery and certain time points (2, 4 and 6 h post-operative), were recorded. The amount of bleeding, surgeon satisfaction and dose of propofol used, side effects and haemoglobin level before and 12 h after surgery were registered. Data analysis was conducted using the SPSS software by one-way analysis of variance, repeated measurement test and Chi-square test at a significance level of 0.05. Results: No significant difference was found in vital signs, including SaO2, blood pressure, HR, duration of surgery, extubation time and the amount of propofol consumed, side effects and haemoglobin level (P > 0.05). Nevertheless, the DXM group showed a prolonged recovery time (P = 0.018), less bleeding (P = 0.001) and the highest surgeon satisfaction (P = 0.001) when compared with other groups. Conclusion: Our results showed that DXM helps increase surgeon satisfaction and reduce bleeding while increasing the recovery time. Overall, it does, however, have improved performance without any side effects, based on which DXM can hence be recommended to be used to control bleeding during craniotomy.