title: Regional Anesthesia to Scalp for Craniotomy: Innovation With Innervation.
abstract: BACKGROUND
  Effective management and pain prevention is of great importance to avoid postoperative complications such as hypertension, agitation, and vomiting. All these adverse events may lead to elevation in intracranial pressure and, in turn, unfavorable outcome and prolonged hospital stay. Development of multiple methods of analgesia may contribute to the alleviation of problems due to pain. We tested the effectiveness of bilateral maxillary block with greater and lesser occipital nerve block for providing analgesia to the scalp.
  
  
  METHODS
  This study was undertaken in 40 patients scheduled for craniotomy. Before skin incision, patients were assigned randomly to receive either bilateral maxillary (group M) or scalp block (group S). Data on intraoperative hemodynamics, postoperative analgesia, and sedation were collected and analyzed for statistical significance.
  
  
  RESULTS
  The primary outcome was the visual analog pain score. It was similar between the 2 groups at 1, 2, and 4 hours after extubation. At 12 hours, the maxillary block group had better analgesia (mean visual analog score: 3.4 cm for group M and 4.1 cm for group S with P-value of 0.0002) and sedation scores. Intraoperatively, there was no difference in the heart rate, blood pressure, and the anesthetic requirements between both the groups. Three patients in group S required fentanyl supplementation in the intraoperative period. There were no adverse events noted in the perioperative period among both the groups.
  
  
  CONCLUSIONS
  Maxillary block along with greater and lesser occipital nerve block is an effective alternative to scalp block for craniotomy and has longer duration of analgesia.
authors.affiliation: Department of Anesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, India.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Jayaram
authors.forename: Moningi
authors.initials: M
authors.lastname: Srilata
authors.forename: Dilipkumar
authors.initials: D
authors.lastname: Kulkarni
authors.forename: Gopinath
authors.initials: G
authors.lastname: Ramachandran
mesh_terms: D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D003399:Craniotomy; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D012535:Scalp / Q000187:drug effects* / Q000601:surgery