Background and Aims Postoperative pain is common after craniotomies and is often left untreated, to avoid masking any developing new neurosurgical pathology. The main cause of postoperative pain relates to the skin incision and the reflection of muscles intra-operatively, rather than brain manipulation. The scalp nerve block (SNB) anaesthetises both the deep and superficial layers of the scalp. From our experience since 2010, scalp blocks have been found to reduce postoperative pain and opioid consumption in the first 48 post-operative hours.

Methods We analysed data from patients undergoing craniotomies under general anaesthesia with bilateral scalp blocks with ropivacaine 0.5%. Induction and maintenance of general anaesthesia was performed via target-controlled infusion of Propofol and remifentanil and neuromuscular blockage was provided with rocuronium. Standard monitoring was applied. The SNB was performed before skin incision, and at least 10 minutes before application of the Mayfield skull clamp, by administering 20 mls of ropivacaine 0.5%. In addition to the block, routine post-operative analgesia was achieved with paracetamol (2g) and Fentanyl (100mcg).

Results 1600 patiens were identified over a period of 11 years.Postoperative pain was assessed using NPRS. In the first hour following surgery, only 5% of the patients were found with moderate pain, and none had severe. Severe pain was reported by only 15% of the patients within the first 12 hours, and significant pain was reported by 60% of patients within the first 48 hours.

Conclusions Bilateral SNBs are shown to provide a good post-craniotomy analgesia,and efficiently reduce the requirement for rescue analgesia in the first 4 hours post procedure.