Blockade of the Peripheral Nerves in the Anesthetic Management of Neurosurgical Interventions on the Head

Abstract

Objective: to evaluate the effectiveness of peripheral nerve blockades innervating the scalp, in combination with general anesthesia in intra- and postoperative analgesia in patients with neurosurgical interventions. Materials and methods. The efficiency of 105 blockages of the peripheral nerves of the scalp in 18 patients with neurosurgical interventions on the head was evaluated. The age of the patients was 47.5 ± 15.5 years. Patients were operated on for intracranial traumatic and non-traumatic hematomas, brain tumors and the need for plastic of postoperative skull defects. The technique of blockade of the nerves of the head is described: supratrochlear, supraorbital, zygomaticotemporal, auriculotemporal, greater auricular, greater and lesser occipital nerves. The technique of ultrasound imaging of the great occipital and auriculotemporal nerves is presented. Results. In all 18 patients, according to intra- and postoperative monitoring, adequate anesthesia was provided. In 2 of 18 patients, an additional fentanyl injection was required to skin incisiondue to an increase in blood pressure and heart rate by 25% of the baseline values, and an increase in CSI until 82 units. The volume of local anesthetic for blockade in one patient was 7.68 ± 1.67 ml of ropivacaine or of bupivacaine. Time for blockade in one patient was 11.4 ± 4.0 minutes. The intensity of pain on a linear visual analog scale in the first day was 0.3-2 points. Conclusion. Blockages of the peripheral nerves of the head were effective in 16 (88.9%) of 18 patients. The safety of blockades was provided by using small volumes (7.68 ± 1.67 ml ) of 0.75-1.0% solution of ropivacaine or 0.5% solution of bupivacaine.