Scalp block for awake craniotomy: Lidocaine-bupivacaine versus lidocaine-bupivacaine with adjuvants Yasser M. Nasra , Salwa H. Waly a and Ahmed A. Morsyb a Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt; b Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt ABSTRACT Methodology: Forty patients were randomly allocated into 4 equal groups based on LA mixture used for scalp block: Group I:received 1.5 mg/kg bupivacaine 0.25% + 5 mg/kg lidocaine 1% with 1:200,000 epinephrine. Group II:same as Group I + 8 mg dexamethasone. Group III:same as Group I + 500 mgMgSO4. Group IV:same as Group I + 8 mgdexamethasone + 500 mgMgSO4. Dexmedetomidine was used for intraoperative sedation and paracetamol for postoperative analgesia. Results: Total intra-operative consumption of dexmedetomidine was highly significantly less in Group II (232 ± 21 µg) and Group III (241 ± 18 µg) compared to Group I (286 ± 27 µg). Group IV (162 ± 25 µg) was highly significantly less than other groups. Time to first paracetamol requirement was highly significantly longer in Group II (245 ± 32 min) and Group III (236 ± 28 min) compared to Group I (187 ± 17 min). Group IV (388 ± 14 min) showed a highly significant longer time than other groups. Group IV consumed highly significant less doses of paracetamol in the first postoperative day (POD1) (2.2 ± 0.1 g) than Group I (2.9 ± 0.4 g), Group II (2.7 ± 0.3 g) and Group III (2.8 ± 0.5 g).Pain in POD1 was significantly higher in Group I at after 3 h of surgery compared to other groups. VAS was comparable during the rest of the times of the study among the four groups. All patients were hemodynamically stable during times of the study. Blood glucose levels were within normal levels with no significant differences between the groups within 6 hof scalp block. Conclusion: Adding either 8 mg©dexamethasone or 500 mg©MgSO4 or both to bupivacainelidocaine for scalp block before awake craniotomy improves performance of the block with the best results when combined.