#: locale=en-US ## Acción ### URL LinkBehaviour_2E5B55E3_3D32_92AD_41A9_630D05885172.source = https://www.11.novovirtual.com/ ## E-Learning ### Nombre Puntuación score1.label = Puntuación 1 ### Pantalla Fin de Tiempo quizTimeout_4B490558_4544_0320_41AC_655199C46BB1.title = - TIMEOUT - quizTimeout_4B490558_4544_0320_41AC_655199C46BB1.repeat = Repeat quizTimeout_4B490558_4544_0320_41AC_655199C46BB1.score = View Score ### Pantalla Pregunta quizQuestion_4B495559_4544_0320_41B6_0946CFCB994A.ok = OK ### Pantalla Reporte quizScore_4B476559_4544_0320_4186_11094495AEB6.title = - SCORE - quizScore_4B476559_4544_0320_4186_11094495AEB6.completion = Completed quizScore_4B476559_4544_0320_4186_11094495AEB6.questionsCorrect = Correct quizScore_4B476559_4544_0320_4186_11094495AEB6.downloadCSV = Download .csv quizScore_4B476559_4544_0320_4186_11094495AEB6.questionsIncorrect = Incorrect quizScore_4B476559_4544_0320_4186_11094495AEB6.items = Items Found quizScore_4B476559_4544_0320_4186_11094495AEB6.questions = Questions quizScore_4B476559_4544_0320_4186_11094495AEB6.repeat = Repeat quizScore_4B476559_4544_0320_4186_11094495AEB6.submitToLMS = Submit quizScore_4B476559_4544_0320_4186_11094495AEB6.elapsedTime = Time ## Hotspot ### Texto HotspotPanoramaOverlayTextImage_1D250308_0F04_EC34_41AC_FE6B6B1C0B2C.text = ANESTHESIOLOGIST HotspotPanoramaOverlayTextImage_19974363_0E0E_2293_4183_581C68E68B39.text = INFO 1 HotspotPanoramaOverlayTextImage_19055FD1_0E0F_E18F_4168_AEE1940EC262.text = INFO 2 HotspotPanoramaOverlayTextImage_1918D6F0_0E0A_E38D_41A1_16F1346F57C6.text = INFO 3 HotspotPanoramaOverlayTextImage_0993AD59_13FB_5388_41A1_895C67C68011.text = INFO 5 HotspotPanoramaOverlayTextImage_0E84C348_13EB_F788_41AB_CB11D34ABBBA.text = INFO 6 HotspotPanoramaOverlayTextImage_1D6E279E_0F04_944C_41A5_D0F0E43E12F3.text = JULIANA HotspotPanoramaOverlayTextImage_1EFABE48_0F04_9433_41A2_0AD3DF823594.text = SURGEON ## Media ### Audio 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Adequate Analgesia: The scalp block provides effective analgesia so that the patient does not experience pain during the scalp incision and cranial manipulation.
Patient Cooperation:
Adequate analgesia favors patient cooperation and helps reduce the doses of sedatives and analgesics, allowing the patient to remain conscious and cooperative during the critical phases of the procedure.
Minimize Deep Sedation: To avoid losing patient cooperation and spontaneous ventilation.
Hemodynamic Stability: To avoid abrupt changes in blood pressure, either hypertension due to nociceptive stimuli or hypotension due to higher drug requirements.
Immediate Neurological Evaluation:
Allow immediate and continuous neurological evaluation during the procedure. This includes the ability to perform functional brain mapping and monitor the patient's response to specific stimuli to avoid damage to critical brain areas.
Reduction of Stress Response.



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Adequate Analgesia: The scalp block provides effective analgesia so that the patient does not experience pain during the scalp incision and cranial manipulation.
Patient Cooperation:
Adequate analgesia favors patient cooperation and helps reduce the doses of sedatives and analgesics, allowing the patient to remain conscious and cooperative during the critical phases of the procedure.
Minimize Deep Sedation: To avoid losing patient cooperation and spontaneous ventilation.
Hemodynamic Stability: To avoid abrupt changes in blood pressure, either hypertension due to nociceptive stimuli or hypotension due to higher drug requirements.
Immediate Neurological Evaluation:
Allow immediate and continuous neurological evaluation during the procedure. This includes the ability to perform functional brain mapping and monitor the patient's response to specific stimuli to avoid damage to critical brain areas.
Reduction of Stress Response.



HTMLText_0A66B55E_29B6_C9B4_41AC_AB7EF61C37BD.html =
Adequate Analgesia: The scalp block provides effective analgesia so that the patient does not experience pain during the scalp incision and cranial manipulation.
Patient Cooperation:
Adequate analgesia favors patient cooperation and helps reduce the doses of sedatives and analgesics, allowing the patient to remain conscious and cooperative during the critical phases of the procedure.
Minimize Deep Sedation: To avoid losing patient cooperation and spontaneous ventilation.
Hemodynamic Stability: To avoid abrupt changes in blood pressure, either hypertension due to nociceptive stimuli or hypotension due to higher drug requirements.
Immediate Neurological Evaluation:
Allow immediate and continuous neurological evaluation during the procedure. This includes the ability to perform functional brain mapping and monitor the patient's response to specific stimuli to avoid damage to critical brain areas.
Reduction of Stress Response.



HTMLText_0F6C8613_1C78_C776_41B8_B24930DD5BE4.html =
Adequate Analgesia: The scalp block provides effective analgesia so that the patient does not experience pain during the scalp incision and cranial manipulation.
Patient Cooperation:
Adequate analgesia favors patient cooperation and helps reduce the doses of sedatives and analgesics, allowing the patient to remain conscious and cooperative during the critical phases of the procedure.
Minimize Deep Sedation: To avoid losing patient cooperation and spontaneous ventilation.
Hemodynamic Stability: To avoid abrupt changes in blood pressure, either hypertension due to nociceptive stimuli or hypotension due to higher drug requirements.
Immediate Neurological Evaluation:
Allow immediate and continuous neurological evaluation during the procedure. This includes the ability to perform functional brain mapping and monitor the patient's response to specific stimuli to avoid damage to critical brain areas.
Reduction of Stress Response.



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-Scalp block involves the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater auricular, and greater and lesser occipital nerves.
-Useful in pediatric and adult patients.
-Allows for intraoperative neurological mapping.


The benefits of ultrasound-guided scalp block include:
-Precise identification of nerves and bony structures.
-Low volumes of local anesthetic.
-Reduced risk of intravascular injection and systemic toxicity.
-High success rates.
HTMLText_35DDAEBA_28B6_C1B8_41BF_5DADE88D3C78.html =
-Scalp block involves the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater auricular, and greater and lesser occipital nerves.
-Useful in pediatric and adult patients.
-Allows for intraoperative neurological mapping.


The benefits of ultrasound-guided scalp block include:
-Precise identification of nerves and bony structures.
-Low volumes of local anesthetic.
-Reduced risk of intravascular injection and systemic toxicity.
-High success rates.



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Auriculotemporal Nerve Block:


The transducer is placed in a transverse plane, 1 cm anterior and cephalic to the tragus, using Doppler to locate the superficial temporal artery. The auriculotemporal nerve is located posterior to the artery. We advance the needle toward the nerve and administer 2 ml of local anesthetic (corresponding ultrasound image).
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Greater Auricular Nerve Block:


We place the transducer in a transverse position on the lateral aspect of the neck, identifying the posterior border of the sternocleidomastoid muscle. The greater auricular nerve is a hypoechoic structure observed superficial to the muscle, blocked using 2 ml of local anesthetic (corresponding ultrasound image).
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Lesser Occipital Nerve Block :


The lesser occipital nerve emerges from the superficial cervical plexus like the greater auricular nerve. The lesser occipital nerve emerges at the posterior border of the sternocleidomastoid at C1 or C2 level. It is thinner and may be difficult to visualize at this level.


At the occipital level, we place the transducer in a transverse position and identify the occipital artery with color Doppler. The lesser occipital nerve is lateral to the artery and can be blocked with 2 ml of local anesthetic (corresponding ultrasound image).
________________
Interfascial Approach for the Greater Occipital Nerve:


Scan from cranial to caudal, starting at the midline over the external occipital protuberance, then move the transducer caudally to observe the posterior arch of the Atlas below the occiput and then at the C2 level (bifid spinous process of the Axis). Then move laterally to visualize the inferior oblique muscle of the head (hypoechoic), deep to the semispinalis capitis muscle. The Greater Occipital Nerve (hyperechoic and oval-shaped) is located between the fascia of these two muscles.


The preferred patient position is lateral decubitus, cervical spine in anteflexion without lateral flexion, with an in-plane puncture from lateral to medial, and 3 to 5 milliliters of local anesthetic are administered in the plane between the fascia of the inferior oblique muscle and the semispinalis capitis.
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Supraorbital Nerve Block :
We place the transducer over the superior orbital rim, in a transverse position. We identify the foramen and the supraorbital artery. The supraorbital nerve is located lateral to the artery. We advance the needle near the nerve and administer the local anesthetic (corresponding ultrasound image).
______________
Supratrochlear Nerve Block :
The supratrochlear nerve is located approximately 1 to 1.5 cm medial to the supraorbital nerve. We infiltrate an additional 2 ml of local anesthetic in this area to ensure a complete block.
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Zygomatic Temporal Nerve Block:


For the zygomatic temporal nerve block, we place the transducer in a coronal plane on the lateral edge of the zygomatic bone, identifying the temporal fascia, deep temporal artery, and the temporal muscle.


The nerve is not directly visible but is blocked by administering 2-3 ml between the bone and the temporal muscle. Ultrasound helps avoid arterial puncture.


We then withdraw the guide to the subcutaneous plane and inject 2-3 ml as the nerve gives rise to a superficial branch after piercing the temporal fascia.
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________________
Auriculotemporal Nerve Block:


The transducer is placed in a transverse plane, 1 cm anterior and cephalic to the tragus, using Doppler to locate the superficial temporal artery. The auriculotemporal nerve is located posterior to the artery. We advance the needle toward the nerve and administer 2 ml of local anesthetic (corresponding ultrasound image).
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________________
Greater Auricular Nerve Block:


We place the transducer in a transverse position on the lateral aspect of the neck, identifying the posterior border of the sternocleidomastoid muscle. The greater auricular nerve is a hypoechoic structure observed superficial to the muscle, blocked using 2 ml of local anesthetic (corresponding ultrasound image).
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________________
Lesser Occipital Nerve Block :


The lesser occipital nerve emerges from the superficial cervical plexus like the greater auricular nerve. The lesser occipital nerve emerges at the posterior border of the sternocleidomastoid at C1 or C2 level. It is thinner and may be difficult to visualize at this level.


At the occipital level, we place the transducer in a transverse position and identify the occipital artery with color Doppler. The lesser occipital nerve is lateral to the artery and can be blocked with 2 ml of local anesthetic (corresponding ultrasound image).
________________
Interfascial Approach for the Greater Occipital Nerve:


Scan from cranial to caudal, starting at the midline over the external occipital protuberance, then move the transducer caudally to observe the posterior arch of the Atlas below the occiput and then at the C2 level (bifid spinous process of the Axis). Then move laterally to visualize the inferior oblique muscle of the head (hypoechoic), deep to the semispinalis capitis muscle. The Greater Occipital Nerve (hyperechoic and oval-shaped) is located between the fascia of these two muscles.


The preferred patient position is lateral decubitus, cervical spine in anteflexion without lateral flexion, with an in-plane puncture from lateral to medial, and 3 to 5 milliliters of local anesthetic are administered in the plane between the fascia of the inferior oblique muscle and the semispinalis capitis.
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________________
Supraorbital Nerve Block :
We place the transducer over the superior orbital rim, in a transverse position. We identify the foramen and the supraorbital artery. The supraorbital nerve is located lateral to the artery. We advance the needle near the nerve and administer the local anesthetic (corresponding ultrasound image).
________________
Supratrochlear Nerve Block :
The supratrochlear nerve is located approximately 1 to 1.5 cm medial to the supraorbital nerve. We infiltrate an additional 2 ml of local anesthetic in this area to ensure a complete block.
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________________
Zygomatic Temporal Nerve Block:


For the zygomatic temporal nerve block, we place the transducer in a coronal plane on the lateral edge of the zygomatic bone, identifying the temporal fascia, deep temporal artery, and the temporal muscle.


The nerve is not directly visible but is blocked by administering 2-3 ml between the bone and the temporal muscle. Ultrasound helps avoid arterial puncture.


We then withdraw the guide to the subcutaneous plane and inject 2-3 ml as the nerve gives rise to a superficial branch after piercing the temporal fascia.
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Key points to remember
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Key points to remember
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SPECIFIC GOALS
HTMLText_0F6CC613_1C78_C776_41B6_B7F5F2CD49CF_mobile.html =
SPECIFIC GOALS
HTMLText_0A66355E_29B6_C9B4_4193_83089F8227E6.html =
SPECIFIC GOALS
HTMLText_0F6CC613_1C78_C776_41B6_B7F5F2CD49CF.html =
SPECIFIC GOALS
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_______________________________
SCALP BLOCK NERVES.


The trigeminal nerve composed of three branches, the ophthalmic nerve, which gives rise to the frontal nerve, which enters the orbit through the superior orbital fissure, giving two branches: Supraorbital nerve and supratrochlear nerve, which innervate the anterior scalp, eyelids, and frontal muscle.


The maxillary nerve, the second branch of the trigeminal nerve, which divides into the zygomaticofacial, zygomaticotemporal, and infraorbital nerves, providing innervation to the skin of the cheek and the zygomatic arch.
Lastly, the mandibular branch, which gives rise to the auriculotemporal nerve responsible for innervating the area above and in front of the scalp at the level of the earlobe.


The C2 and C3 roots are responsible for innervating the posterior area of the scalp through the greater occipital and lesser occipital nerves.
Scalp block prevents the conduction of nerves that provide sensation to the scalp, providing effective analgesia during the most painful parts of surgery, Therefore, scalp block is crucial for managing pain during procedures such as head frame fixation, incision, and skull drilling. It is a key component for overall success in awake craniotomy. It facilitates a safe and effective intervention, significantly improving postoperative outcomes and the patient's quality of life.
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This is a representation


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SCALP BLOCK NERVES.


The trigeminal nerve composed of three branches, the ophthalmic nerve, which gives rise to the frontal nerve, which enters the orbit through the superior orbital fissure, giving two branches: Supraorbital nerve and supratrochlear nerve, which innervate the anterior scalp, eyelids, and frontal muscle.


The maxillary nerve, the second branch of the trigeminal nerve, which divides into the zygomaticofacial, zygomaticotemporal, and infraorbital nerves, providing innervation to the skin of the cheek and the zygomatic arch.
Lastly, the mandibular branch, which gives rise to the auriculotemporal nerve responsible for innervating the area above and in front of the scalp at the level of the earlobe.


The C2 and C3 roots are responsible for innervating the posterior area of the scalp through the greater occipital and lesser occipital nerves.
Scalp block prevents the conduction of nerves that provide sensation to the scalp, providing effective analgesia during the most painful parts of surgery, Therefore, scalp block is crucial for managing pain during procedures such as head frame fixation, incision, and skull drilling. It is a key component for overall success in awake craniotomy. It facilitates a safe and effective intervention, significantly improving postoperative outcomes and the patient's quality of life.
HTMLText_01A76FE3_284F_5893_41C0_6275D4630ADC_mobile.html =
This is a representation


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