Postoperative analgesia for craniosynostosis reconstruction: Scalp nerve block or local anesthetic infiltration?

Regional anesthesia for head and neck neurosurgical procedures: a narrative review in adult and pediatric patients

“…In a retrospective case series review of 78 cases by Rothera et al, 70 scalp blocks reduced intraoperative remifentanil requirements but had no impact on intraoperative longer-acting opiate and blood transfusion requirements. In contrast, a retrospective case-control comparative study of 81 children undergoing craniosynostoses repair demonstrated a greater need for postoperative morphine rescue analgesia and total morphine doses in the recovery room in children who had received a scalp block 71 . Ultrasound-guided peripheral nerve blocks have also been described for pediatric ventriculoperitoneal (VP) shunt surgery.…”

“…In contrast, a retrospective casecontrol comparative study of 81 children undergoing craniosynostoses repair demonstrated a greater need for postoperative morphine rescue analgesia and total morphine doses in the recovery room in children who had received a scalp block. 71 Ultrasound-guided peripheral nerve blocks have also been described for pediatric ventriculoperitoneal (VP) shunt surgery. Namely, a greater occipital nerve block and superficial CPB can be combined with either a transversus abdominis plane block or intercostal nerve block (depending on the trajectory of the tunneling path) to decrease postoperative analgesic requirements.…”

Pre-emptive scalp infiltration with ropivacaine plus methylprednisolone versus ropivacaine alone for relief of postoperative pain after craniotomy in children (RP/MP vs RP): a study protocol for a randomised controlled trial

“…Scalp infiltration with local anaesthetics is the simplest and most effective method of preventing postoperative incisional pain in paediatric patients 11 12. Cercueil et al reported that children younger than 2 years of age who received local anaesthetic infiltration had a decreased need for postoperative morphine 13. Local infiltration with a single anaesthetic only provides significant pain relief for a brief period, so many patients have significant pain after the local anaesthetics have dissipated.…”