There are several previous studies demonstrating that regional scalp nerve block provides better hemodynamics and pain control for brain surgery. Many cervical spine surgery also require cranial fixation which often cause significant hemodynamic change. Aim of this study is to exam if scalp nerve block provides similar benefit as well.
     We reviewed all consecutive adult patients underwent elective cervical spine surgery during 2015/05 and 2015/10. All patients received endotracheal general anesthesia induction with fentanil, propofol/ thiamylal and cisatracurium/ rocuronium followed by sevoflurane/ desflurane/ propofol maintainance. If a patient was selected to receive regional scalp nerve block by his/ her anesthesiologist, 0.5% levobupivacaine or 2% lidocaine about 3ml was injected each site for auriculotemporal and lesser occipital nerve after general anesthesia induction. We do not perform greater occipital nerve block to avoid possible cervical nerve damage when positioning. Heart rate and blood pressure were monitored during cranial fixation, if significant hemodynamic change was noticed, increasing anesthesia depth and/ or adding fentanil/ antihypertensive drugs was selected by the anesthesiologist.
     During these six months, there were 109 elective adult cervical spine surgeries, 47 of them required cranial fixation. All 47 were put into prone position with head fixed with Mayfield skull clamp. Thirteen patient received regional scalp nerve block and 34 didn´t. The baseline HR, SBP, DBP were 79 vs 78, 147 vs 138, 79 vs 84 in control and nerve block groups. During cranial fixation, the HR, SBP, DBP were 89(+14%) vs 86(+11%), 128(-12%) vs 115(-15%), 81(+2%) vs 71(-15%) in control and nerve block groups. The DBP change value and percentage were significantly different (p-value 0.02). There was no adverse event caused by regional scalp nerve block.
     In patients with regional block to auriculotemporal and lesser occipital nerve, the hemodynamic control, especially DBP is better than patients without regional scalp nerve block. It is an effective and safe technique for cervical spine surgery requiring cranial fixation.

Regional scalp nerve block provides better blood pressure control for cervicle spine surgery