Levobupivacaine scalp nerve block in children

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial

“…Additionally, the outcomes of levobupivacaine scalp blocks in paediatric patients were evaluated in a case series of three patients who received the blocks before craniotomy. 17 Levobupivacaine resulted in good haemodynamic stability and reduced the need for opioids during the first 24 hours. In line with these previous findings, the present study revealed better intraoperative haemodynamics in the levobupivacaine than control group as evidenced by the significantly lower MAP and HR during head pinning and incision.…”

‘Anesthesia’ for awake neurosurgery

“…The investigators concluded that the selective trigeminal nerve block is more effective than local infiltration for scalp block in controlling hemodynamic responses and in preventing the increased stress hormone response to skull-pin fixation for craniotomies. Also in children undergoing general anesthesia for craniotomy, scalp nerve block with levobupivacaine 0.25% (2 mg/kg) with epinephrine 2.5 mcg/ml seems a well tolerated and effective procedure that prevents and reduces postoperative pain [22 ]. These observations might extend to patients receiving local anesthesia for awake neurosurgery.…”

The Use of “Scalp Block” in Pediatric Patients

“…This block was used as an adjunct to propofol/remifentanil based anesthetic during awake craniotomy and tumor resection in an adolescent patient [17]. Infiltration of the supraorbital, supratrochlear, auriculotemporal, greater auricular, greater occipital, and lesser occipital in an 8-year-old girl undergoing a thalamic tumor resection with levobupivicaine 0.25%, was also recently shown to prevent the hemodynamic response to skull-pin placement and decrease the need for opioids [18]. This "extended scalp block" (infiltration of the supraorbital, supratrochlear, auriculotemporal, and posterior auricular nerves) in patients undergoing neurovascular reconstruction surgery resulted in more stable hemodynamic parameters, with lower concentrations of inhaled anesthetics (sevoflurane) needed, and decreased morbidity compared to the control group [19].…”