APPLICATION OF SCALP BLOCK AS A REGIONAL ANESTHETIC TECHNIQUE FOR ELECTIVE AND EMERGENCY CRANIOTOMY

Abstract

Almost 90% of patients who undergo craniotomy experience postoperative pain that is poorly controlled in the early postoperative period. As many as half of them are considered to have moderate to severe headaches caused by the surgical procedure. The use of opiates in the intraoperative and postoperative period is the most common method for pain management. Scalp block is a regional anesthetic technique in which local anesthetic is infused near the nerves that innervate the scalp, thus providing quality intraoperative and postoperative analgesia. When applying the scalp block, 2 ml of local anesthetic is infiltrated at 5 sites on the side where the craniotomy will be performed. The scalp block blocks n.supraorbitalis and n.supratrochlearis; n.auriculotemporalis; n.occipitalis major and n.occipitalis minor. When applying the scalp block, long-acting local anesthetics such as bupivacaine or ropivacaine are used, while a combination of lidocaine and bupivacaine is also possible. Systemic application of corticosteroids prolongs the analgesic effect of the block for up to 48 hours, and according to some authors, up to 72 hours. The scalp block drastically reduces the need for opiates in the intraoperative period and provides complete hemodynamic stability (1). According to the meta-analysis by D. Taylor and colleagues, scalp blocks reduce opioid consumption in the first 24 and 48 hours postoperatively, and also significantly reduces pain by 2/10 in the first 24 hours after the surgical procedure, with the possibility of extending the analgesic effect for up to 48 hours (2)(3). Additionally, scalp block significantly or completely attenuates the hemodynamic effects of craniotomy, providing hemodynamic stability immediately after its application (2)(3). According to the ESAIC recommendations for the management of craniotomy-related pain issued in 2023, analgesia for craniotomy should consist of scalp block combined with intraoperative administration of paracetamol, with or without continuous infusion of dexmedetomidine, while opiates are considered only as salvage therapy when all other modalities have failed (4).