الفهرس 
Anatomy and nerve blocksOnly 14 pages are availabe for public view
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Abstract
The incidence of hydrocephalus is between 0.3-1.5 per 100 live births in the United States. Ventriculomegaly alone occurs in approximately 0.5-2 per 100 live births. Surgical correction involves draining fluid from the ventricular system to one of three places: peritoneum, atrium, or the pleural cavity. The most common choice is a ventriculoperitoneal (VP) shunt. (1) Regional anesthesia has been often combined with general anesthesia to provide patients with a synergistic multimodal approach to analgesia and hemodynamic stability. (2) The regional anesthetic technique in scalp is an underutilized technique, which is relatively easy to perform with great benefits to patients. (3) Similarly to its use in adults, may be used in children undergoing a variety of neurosurgical procedures. The utilization of local nerve blocks of the scalp in children may thus provide analgesia with stable hemodynamics while reducing the need for other anesthetics such as inhaled anesthetics and opioids. This could in turn result in less side effects, higher patient and family satisfaction, and better outcomes.(4) Around two thirds of patients report moderate to severe pain after craniotomy in prospective studies, and surveys of analgesia management indicate there is little consensus on best practice.(5,6) Furthermore, there is specific concern that providing pain relief with systemic opioids in the postoperative period after neurosurgical procedures may cloud neurological assessment and obscure early signs of intracranial complications.(7) In addition, regional blocks are simple, inexpensive and can reduce neurohormonal responses induced by tissue injuries. (8)
The superficial cervical plexus (SCP) block results in anesthesia of the skin of the anterolateral neck and the anteauricular and retroauricular areas, as well as the skin overlying and immediately inferior to the clavicle on the chest wall. Advantages of ultrasound guided superficial cervical technique over the landmark based technique include: the ability to ensure the spread of local anesthetic solution in the correct plane increasing the success rate, avoiding too deep needle insertion and/or inadvertent puncture of neighboring structures. (9)
Greater occipital nerve (GON) block which derives most of its fibers from the C2 dorsal root, is the main sensory nerve of the occipital area, and has been frequently used for different types of headache. Ultrasound guided GON block is likely to be a more effective technique than blind blockade in occipital headache treatment. (10)
Levobupivacaine/epinephrine scalp nerve block may provide better hemodynamic stability at skin incision and closure, and possibly reduce the need for supplementary opioids. (11) Levobupivacaine also improves recovery profiles in that it effectively lowers postoperative pain and fentanyl consumption without severe adverse events. (12)
To the best of our knowledge, no previous studies were performed to assess the analgesic efficiency of the SCP block and GON block in VP shunts in pediatrics. However, there was a single case report that demonstrated the analgesic benefits of these two blocks combined with Transversus Abdominis Plane block in such surgeries. (13)