Scalp block [Neurosurgery Wiki]

This page is read only. You can view the source, but not change it. Ask your administrator if you think this is wrong.
====== Scalp block ======
Scalp [[block]] is quite indispensable for an [[awake craniotomy]]. The branches of [[cranial nerve]]s blocked are supratrochlear, supraorbital, auriculotemporal, greater and lesser occipital, great auricular, zygomatic and infraorbital nerves. Local anesthetic (40-60 mL) with epinephrine assures long duration of block. Large volume of local anesthetic and well-vascularized areas predispose to anesthetic toxicity hence individual nerve blocks are preferred over wide areas of infiltration to decrease probability of LA toxicity. The use of adrenaline (5 μg/mL, 1:200 000 dilution) both minimizes acute rise in plasma concentration and maximizes the duration of the block. Clinical hyper vigilance is particularly indicated within the first 15 min after scalp block.

Bupivacaine is still the most commonly used local anesthetic but ropivacaine and levobupivacaine appear to be safer than bupivacaine.

In awake-awake-awake technique 28 ml ropivacaine 0.75% with epinephrine 1:200000 and 9 ml of a 1:1 mixture of ropivacaine 0.75% and prilocaine 1.0% at pin sites was used to avoid delay to full effect of the scalp block.
----
Better hemodynamics and less antihypertensive medication: Comparison of scalp block and local infiltration anesthesia for skull-pin placement in awake deep brain stimulation surgery
((Krauss P, Marahori NA, Barth F, Oertel MF, Stieglitz LH. Better hemodynamics
and less antihypertensive medication: Comparison of scalp block and local
infiltration anesthesia for skull-pin placement in awake deep brain stimulation
surgery. World Neurosurg. 2018 Sep 6. pii: S1878-8750(18)31996-X. doi:
10.1016/j.wneu.2018.08.210. [Epub ahead of print] PubMed PMID: 30196173.
)).

===== Evidence =====

There is high-[[quality]] [[evidence]] that [[Nonsteroidal antiinflammatory drug]]s reduces pain up to 24 hours postoperatively. The evidence for reductions in pain with [[dexmedetomidine]], [[pregabalin]] or [[gabapentin]], [[scalp block]]s, and [[scalp]] [[infiltration]] is less certain and of very low to moderate quality. There is low-quality evidence that scalp blocks and dexmedetomidine may reduce additional analgesics requirements. There is low-quality evidence that [[gabapentin]] or [[pregabalin]] may decrease nausea and vomiting, with the caveat that the total number of events for this comparison was low
((Galvin IM, Levy R, Day AG, Gilron I. Pharmacological interventions for the
prevention of acute postoperative pain in adults following brain surgery.
Cochrane Database Syst Rev. 2019 Nov 21;2019(11). doi:
10.1002/14651858.CD011931.pub2. Review. PubMed PMID: 31747720.
)).