Abstract
Regional anesthesia has been an undervalued entity in neuroanesthetic practice. However, in the past few years, owing to the development of more advanced techniques, drugs and the prolific use of ultrasound guidance, the unrecognised potential of these modalities have been highlighted. These techniques confer the advantages of reduced requirements for local anesthetics, improved hemodynamic stability in the intraoperative period, better pain score postoperatively and reduced analgesic requirements in the postoperative period. Reduced analgesic requirement translates into lesser side effects associated with analgesic use. Furthermore, the transition from the traditional blind landmark-based techniques to the ultrasound guidance has increased the reliability and the safety profile. In this review, we highlight the commonly practised blocks in the neuroanesthesiologist’s armamentarium and describe their characteristics, along with their individual particularities.
Highlights
Neurosurgical Anesthesiology is a relatively modern subspecialty of anesthesiology, which focusses on the anesthetic management of patients undergoing neurosurgical procedures
Application of regional nerve blocks when combined with general anesthesia during neurosurgery has been seen to provide hemodynamic stability, to decrease anesthetic requirement, as well as extend postoperative analgesia and, is desired
In addition to the authors own experience, a systematic literature search and analyses was performed by using search engines, including the ones provided by PubMed, Google and Google Scholar, with the use of the following singletext words and combinations: anesthesia/anaesthesia, neurosurgery, regional anesthesia/anaesthesia, nerve blocks and other combinations of words, from the year 2000 to 2020
Summary
Neurosurgical Anesthesiology is a relatively modern subspecialty of anesthesiology, which focusses on the anesthetic management of patients undergoing neurosurgical procedures. Maintenance of cerebral and spinal cord perfusion pressure is the foremost consideration for neurosurgical procedure, which depends upon the maintenance of hemodynamic stability and changes in the pain intensity at different stages of surgery[1]. These procedures are usually prolonged, maintaining the same surgical position is difficult, even if the patient is awake or sedated with adequate analgesia. As the surgery is being conducted within narrow anatomical corridors and with high precision, slightest degree of movement by the patient is unacceptable and potentially deleterious. In the face of these concerns, maintenance of general anesthesia with inhalational or intravenous
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