Acute Pain Management Protocol for Cranial Procedures

Targeted blockade of the nerves of the scalp have been found to be beneficial for many different types of surgeries of the head, as well as for some nonsurgical conditions. Craniotomy has been the most widely studied surgical procedure of the head, and it is associated with a high risk of severe acute and chronic pain. Several techniques to combat this pain include the use of multimodal analgesia, infiltration of local anesthetic, and the regional technique of scalp blocks. The common indications for scalp blocks include extracranial surgery, blunting of the hemodynamic response to intracranial surgery, and reducing acute and chronic pain following intracranial surgery. Its evolving role in decreasing acute and chronic pain parallels that of other types of neural blockade, and efforts to find efficacious combinations of procedure, patient, and technique are ongoing. However, the fact that extracranial blockade of the dura is not possible is one of the limits to the analgesia provided by scalp blockade (Papangelou et al., J Clin Anesth 25:150–159, 2013.