A case of temporary facial nerve palsy after regional anesthesia of the scalp.

Abstract

he use of pins to stabilize the head of neurosur- gical patients in a Mayfield head holder causes a painful stimulus that may increase the arterial blood pressure and heart rate (1). To blunt this hemo- dynamic response, several approaches are possible, based on either the IV administration of drugs or the application of local anesthesia. The IV use of alfentanil 2-3 min before applying the Mayfield head holder is effective (2). Although Doblar et al. (2) could not dem- onstrate any effect, a bolus dose of thiopental is also used, but this can cause hemodynamic instability. Lo- cal injection of lidocaine into the scalp where the skull pins are placed is also effective (2), but it poses the problem that the anesthesiologist must know exactly where the surgeon will place the skull pins. Reposi- tioning of the Mayfield head holder also requires ad- ditional injections of a local anesthetic. Pinosky et al. (3) showed that a full scalp block effectively blunts the hemodynamic response to head pinning. They used bupivacaine to block the major nerves that innervate the scalp, as identified by bony landmarks (the supraorbital and supratrochlear nerves; the auriculotemporal nerves; the greater auric- ular nerves; and the greater, lesser, and third occipital nerves). After the publication by Pinosky et al. (3), we incorporated this technique into the clinical care of >50 neurosurgical patients with similar favorable re- sults. We now report a case of postoperative facial nerve block after intraoperative scalp block that rein- forces the need for care in using this procedure.