Scalp Blocks

From Pinosky ML, Fishman RL, Reeves St et al. the effect of bupivacaine skull block on the hemodynamic response to craniotomy. Anesth Analg 1996; 83:1256-1261.

http://journals.lww.com/anesthesia-analgesia/Fulltext/1996/12000/The_Effect_of_Bupivacaine_Skull_Block_on_the.22.aspx

After induction of anesthesia, baseline hemodynamic variables were recorded and the skull block was performed 5 min before head pinning. The supraorbital and supratrochlear nerves were blocked with 2 mL of solution as they emerged from the orbit with a 23-gauge needle introduced above the eyebrow perpendicular to the skin. The auriculotemporal nerves were blocked bilaterally with 5 mL of solution injected 1.5 cm anterior to the ear at the level of the tragus; the needle was introduced perpendicular to the skin and infiltration was made deep to the fascia and superficially as the needle was withdrawn. The postauricular branches of the greater auricular nerves were blocked with 2 mL of solution between skin and bone, 1.5 cm posterior to the ear at the level of the tragus (Figure 1). The greater, lesser, and third occipital nerves were blocked with 5 mL of solution using a 22-gauge spinal needle, with infiltration along the superior nuchal line, approximately halfway between the occipital protuberance and the mastoid process (Figure 2).

scalp blocks - AA1996
Suprorbital foramen is palpable just medial to mid-eyebrow, the supratrocheal foramen is not often palpable, instead find supraorbital and go 1cm medial.

scalp blocks - AA1996_FIG2

occipital-2

Skull dermatomes
Skull dermatomes
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s