Jun 4, 2023
Blocks for Head, Neck, and Spinal Surgeries
In this episode, we will explore the various regional
anesthesia techniques used in neurosurgery, specifically focusing
on blocks for head, neck, and spinal surgeries.
Segment 1: Blocks used in Head and Neck Surgeries
- Scalp Block:
- The scalp block involves blocking six nerves that
provide sensory innervation to the scalp.
- It is performed by subcutaneous infiltration of local
anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine)
for each nerve.
- Ultrasound guidance has improved the precision of
block administration.
- The main indication for a scalp block is awake
craniotomy, but it is also used in other procedures like deep brain
stimulation and cranioplasty surgery.
- Scalp block offers advantages such as accurate
neurological evaluation, pre-emptive analgesia, and hemodynamic
stability during surgery.
- It also reduces postoperative pain, the need for
rescue analgesics, and pain scores in the early postoperative
period.
- Infraorbital Block (IOB):
- The infraorbital nerve block targets the infraorbital
nerve, which supplies the skin and mucous membrane of the upper
lip, lower eyelid, and cheek.
- The IOB can be performed using the classical landmark
technique or ultrasound guidance.
- Ultrasound guidance provides real-time visualization
and accurate needle placement.
- IOB combined with general anesthesia is beneficial for
postoperative pain relief in procedures like endoscopic trans-nasal
trans-sphenoidal (TNTS) approach for pituitary tumor excision.
- Other regional techniques like sphenopalatine ganglion
block and maxillary nerve blocks have also been attempted for
transsphenoidal surgeries.
- Trigeminal Nerve Block:
- Trigeminal nerve block is used for patients
unresponsive to medical management of trigeminal neuralgia.
- Traditionally performed using the paresthesia
technique, ultrasound guidance allows real-time visualization and
confirmation of local anesthetic spread.
- Ultrasound guidance helps locate the Gasserian
ganglion and visualize the trigeminal ganglion, providing a safe
and radiation-free procedure for pain relief.
Segment 2: Blocks used for Spinal Surgeries
- Cervical Plexus Block (CPB):
- CPB is commonly used in carotid endarterectomy (CEA)
and cervical spine surgery.
- Different levels of CPB can be performed depending on
the depth of injection.
- Superficial CPB involves injecting local anesthetic
superficially into the deep cervical fascia.
- Deep CPB requires depositing local anesthetic deep to
the prevertebral fascia.
- CPB helps in monitoring cerebral blood flow during CEA
and provides postoperative pain relief.
- Ultrasound guidance can be used for superficial CPB,
ensuring accurate needle placement and local anesthetic
spread.
- Erector Spinae Block (ESB):
- ESB is used for pain control in spinal surgeries.
- It involves depositing local anesthetic in the plane
between the erector spinae muscle and the transverse process.
- ESB provides effective postoperative analgesia and
reduces opioid consumption.
Regional anesthesia techniques play a crucial role in
neurosurgery, providing effective pain relief and improving patient
outcomes. Blocks like scalp block, infraorbital block, trigeminal
nerve block, cervical plexus block, and erector spinae block offer
numerous advantages in specific procedures. Ultrasound guidance has
enhanced the precision and safety of block administration. These
techniques contribute to improved surgical outcomes and patient
satisfaction in neurosurgical procedures.
Upcoming Courses and Workshops!
Course Calendar
Practice Management Webinar: The End of the Public
Health Emergency. What’s Changed and what Opportunities
Remain!
Pain
Management Board Review/Refresher Course/ Ultrasound Training NYC-
June 9-11, 2023
Ultrasound
Guided Regional Anesthesia and Pain Medicine NYC- July 19,
2023
Ultrasound
Guided Regional Anesthesia and Pain Medicine NYC- August 19th,
2023
Ultrasound
Guided Regional Anesthesia and Pain Medicine- Sept 15, 2023, San
Juan, PR
For up
to date Calendar, Click
Here!
References
Kaushal A, Haldar R. Regional
Anesthesia in Neuroanesthesia Practice. Discoveries (Craiova). 2020
Jun 29;8(2):e111. doi: 10.15190/d.2020.8. PMID: 32637571; PMCID:
PMC7332314.