Evaluation of Response to Pain From Skull Pin Fixation in Craniotomies

The goal of this observational study is to investigate the relationship between the response to skull pin fixation pain and the analysis of blood pressure, heart rate, and brain wave activity in adults undergoing brain surgery. The main questions it aims to answer are:

Does the analysis of blood pressure, heart rate, and brain wave activity indicate the patient's response to skull pin fixation pain during brain surgery? How do the methods used to reduce skull pin fixation pain in brain surgeries affect narcotic opioid consumption? The researchers will monitor the patients' response to skull pin fixation pain during surgery through the analysis of brain wave activity.

Patients with an ASA (American Society of Anesthesiologists) score of I-II who are undergoing elective craniotomy under general anesthesia with the use of a skull clamp will be included in the study. The methods used to manage patients' pin-related pain will be recorded on the follow-up form: 1-intravenous opioids, 2- local anesthetic (LA) injection at the pin site, and 3- scalp block. The patients' hemodynamic responses and their reactions to painful stimuli, as recorded by the BIS-DSA monitor, will be documented during the placement of the skull clamp. These records are automatically archived in the BIS-DSA device. Waveform analyses from the BIS-DSA will later be converted into numerical values using the "Hue formula."

Eligibility Criteria:
Inclusion Criteria:

* Adult patients aged 18-70 years undergoing elective craniotomy.
* Patients classified as ASA I-II according to the American Society of Anesthesiologists (ASA) classification.
* Patients scheduled for surgery under general anesthesia.
* Patients who provide written informed consent to participate in the study.
* Patients with normal cognitive function (i.e., no diagnosed dementia or severe cognitive impairment).
* Patients with a preoperative BIS value within the normal range (i.e., no extreme baseline deviations).

Exclusion Criteria:

* Patients classified as ASA III or higher.
* Patients with neurological disorders (e.g., Parkinson's disease, epilepsy, stroke history).
* Patients with psychiatric disorders (e.g., severe depression, schizophrenia) that may affect pain perception and response.
* Patients with known allergies to local anesthetics or opioids.
* Pregnant or breastfeeding women.
* Patients with contraindications to anesthesia, including but not limited to:
* Severe cardiovascular disease (e.g., uncontrolled hypertension, recent myocardial infarction).
* Severe respiratory disease (e.g., COPD, uncontrolled asthma).
* Patients with any neurological or pharmacological condition that may interfere with BIS-DSA or EEG measurements.
* Patients with preoperative chronic opioid use (≥3 months) due to potential tolerance affecting response to intraoperative analgesia.
* Patients with a history of substance abuse that may alter the BIS response or anesthetic metabolism.
* Patients with significant hearing or communication impairments, preventing them from understanding or responding to preoperative assessments.
* Patients with significant scalp pathology (e.g., infections, scars, large vascular malformations) at the BIS electrode placement site, which may interfere with signal acquisition.