Regional Anesthesia Techniques in Modern Neuroanesthesia Practice: A Narrative Review of the Clinical Evidence

Abstract

Neurosurgical procedures are often associated with significant postoperative pain that is both underrecognized and undertreated. Given the potentially undesirable side effects associated with general anesthesia and with various pharmacological analgesic regimens, regional anesthetic techniques have gained in popularity as alternatives for providing both anesthesia and analgesia for the neurosurgical patient. The aim of this narrative review is to present an overview of the regional techniques that have been incorporated and continue to be incorporated into modern neuroanesthesia practice, presenting in a comprehensive way the evidence, where available, in support of such practice for the neurosurgical patient.

Anesthesia for same day neurosurgery with updates on awake craniotomy and awake spine surgery

“…Adjuvants such as dexamethasone, magnesium sulfate, or both to local anesthetic agents for scalp block, has been shown to improve analgesia and patient satisfaction during awake craniotomies [27]. Moreover, ultrasound-guided scalp blocks are more efficacious than the landmark technique in terms of analgesia and duration of action [30,31 ▪▪ ].…”

“…Regional anesthesia techniques, when compared to general anesthesia, have been associated with favorable hemodynamics, reduced incidence of intraoperative blood loss, deep vein thrombosis, pulmonary embolism, renal failure, and postoperative cognitive dysfunction [31 ▪▪ ]. A meta-analysis of 11 randomized controlled trials (RCT) comparing general anesthesia vs. spinal anesthesia in lumbar spine surgery, concluded that spinal anesthesia decreased postoperative pain and the analgesic requirement, along with reduced incidence of postoperative nausea and vomiting (PONV), and better patient satisfaction.…”

“…Erector spinae plane block (ESP) is a relatively new regional anesthesia technique that has shown promising results in providing analgesia for spine surgeries [31 ▪▪ ]. Ultrasound-guided ESP block reduces the postoperative opioid requirement and offers better patient satisfaction when compared with standard analgesia regimen in lumbar spine surgeries [49].…”

Perioperative Management for Complex Spine Fusion Surgery

“…Specifically, there are some high-quality prospective and randomized studies supporting the use of erector spinae blocks in thoracolumbar surgery, with promising data emerging for other cervical and truncal fascial plane blocks (including multifidius cervicis blocks, intersemispinal plane blocks, thoracolumbar interfascial plane blocks, and quadratus lumborum blocks, among others). 56,57 While an exhaustive description of these various regional techniques lies outside of the scope of this review, this is an area that holds great potential within the perioperative care of complex spine surgery patients, becoming part of standard care pathways and algorithms in some institutional practices.…”