Update on scalp nerve block for craniotomy.

Purpose of review: The purpose of this review is to outline the indications, technique, and ideal local anesthetics and adjuvants that can be administered for scalp nerve block (SNB) in adult patients undergoing craniotomy. SNBs are an effective means to provide patients with analgesia with lower opioid requirements.

Recent findings: Recent literature shows a wide range of neurosurgical procedures can benefit from the administration of scalp blocks. Scalp blocks remain a technically straightforward regional anesthesia technique; however, the literature is insufficient to firmly recommend any specific local anesthetic or adjuvant.

Summary: SNBs should be considered a low risk, technically easy to perform, and highly effective regional anesthesia technique in a wide range of neurosurgical procedures. A long-acting local anesthetic such as ropivacaine, bupivacaine, or levobupivacaine is recommended, and the addition of an adjuvant such as dexmedetomidine, clonidine, or dexamethasone has been shown to prolong the duration of the block. Ultrasound may be useful addition to improve block success.