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Related Concept Videos

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

601
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
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Update on scalp nerve block for craniotomy.

Anna Maria Bombardieri1, Maxim Pochebyt, Mark A Burbridge

  • 1Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine, Stanford, California, USA.

Current Opinion in Anaesthesiology
|June 23, 2025
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Summary

Scalp nerve blocks (SNBs) offer effective, low-risk analgesia for craniotomy patients, reducing opioid needs. Long-acting anesthetics like ropivacaine and adjuvants can enhance SNB duration and success.

Keywords:
adjuvantscraniotomylocal anestheticspostoperative painscalp block

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Regional Anesthesia

Background:

  • Scalp nerve blocks (SNBs) are increasingly recognized for their role in perioperative pain management.
  • They offer a valuable alternative to systemic analgesics, particularly opioids, in neurosurgical patients.

Purpose of the Study:

  • To review the indications, techniques, and optimal local anesthetics and adjuvants for scalp nerve blocks in adult patients undergoing craniotomy.
  • To highlight SNBs as an effective method for providing analgesia and reducing opioid consumption.

Main Methods:

  • Review of recent literature on scalp nerve blocks in neurosurgical procedures.
  • Analysis of anesthetic agents, adjuvants, and adjuncts like ultrasound for improving block efficacy.

Main Results:

  • Scalp blocks are technically straightforward and beneficial for a wide array of neurosurgical procedures.
  • While literature supports their use, specific recommendations for local anesthetics or adjuvants are not yet definitive.
  • Ultrasound guidance may enhance block success rates.

Conclusions:

  • Scalp nerve blocks are a low-risk, technically simple, and highly effective regional anesthesia technique for various neurosurgical operations.
  • Recommended local anesthetics include long-acting agents such as ropivacaine, bupivacaine, or levobupivacaine.
  • Adjuvants like dexmedetomidine, clonidine, or dexamethasone can prolong the block's duration; ultrasound may improve success.