• Eren Fatma Akcil, Ozlem Korkmaz Dilmen, Hayriye Vehid, Lutfiye Serap Ibısoglu, and Yusuf Tunali.
• University of Istanbul, Cerrahpasa School of Medicine, Department of Anesthesiology and Intensive Care, Turkey. Electronic address: erenfat@yahoo.com.

ObjectivesThe most painful stages of craniotomy are the placement of the pin head holder and the skin incision. The primary aim of the present study is to compare the effects of the scalp block and the local anesthetic infiltration with bupivacaine 0.5% on the hemodynamic response during the pin head holder application and the skin incision in infratentorial craniotomies. The secondary aims are the effects on pain scores and morphine consumption during the postoperative 24h.MethodsThis prospective, randomized and placebo controlled study included forty seven patients (ASA I, II and III). The scalp block was performed in the Group S, the local anesthetic infiltration was performed in the Group I and the control group (Group C) only received remifentanil as an analgesic during the intraoperative period. The hemodynamic response to the pin head holder application and the skin incision, as well as postoperative pain intensity, cumulative morphine consumption and opioid related side effects were compared.ResultsThe scalp block reduced the hemodynamic response to the pin head holder application and the skin incision in infratentorial craniotomies. The local anesthetic infiltration reduced the hemodynamic response to the skin incision. As well as both scalp block and local anesthetic infiltration reduced the cumulative morphine consumption in postoperative 24h. Moreover, the pain intensity was lower after scalp block in the early postoperative period.ConclusionThe scalp block may provide better analgesia in infratentorial craniotomies than local anesthetic infiltration.Copyright © 2017 Elsevier B.V. All rights reserved.

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