Ultrasound-Guided Scalp Block for Chronic Subdural Hematoma Evacuation-A Case Series and Review of Literature

Burr hole craniotomy for the evacuation of subdural hematoma (SDH) can be performed under general anesthesia, surgical site local anesthesia, or scalp block. The prevalence of SDH is higher in the geriatric age group who often suffers from multiple comorbidities. The use of general anesthesia with polypharmacy and airway manipulation may adversely affect the systemic physiology in these patients with substantially decreased reserve. Relief of pain is often inadequate with surgical site local anesthesia leading to tachycardia, hypertension, adverse cardiovascular events, and poor patient satisfaction. Scalp block provides dense prolonged blockade of select target nerves and avoids sedation facilitating early recovery and discharge. However, it is associated with multiple complications including intraneural/arterial injection, and local anesthetic systemic toxicity. The use of ultrasound has ushered in a new era in the field of regional anesthesia; however, the use of ultrasound-guided scalp blocks is not routinely practiced. The use of ultrasound has an opioid-sparing effect and avoids complications like facial nerve palsy and hematoma. We report the first case series of successful ultrasound-guided scalp blocks for the evacuation of chronic SDH.