Discussion
toxicity, muscle breaks, pain, cranial suture, nerve block
PERIOSTEUM
In cranial suture reconstruction procedures, skin incision and peeling of the periosteum are the most painful processes and may increase the patient’s blood pressure and HR [Craniotomy-related pain is mainly caused by skin incisions and muscle breaks rather than the operation on the brain parenchyma. The scalp is mainly innervated by the trigeminal nerve and the second and third cervical nerve roots [The MAP and HR at THowever, there were still limitations in this study: the scalp sensory nerves are thin and difficult to distinguish on ultrasonography, and the identification of these nerves requires ultrasound-assisted localization of anatomical landmarks such as bone and blood vessels. However, the fact that there are variants of scalp nerves may affect the accuracy of nerve blocking. The amount of local anesthetic used may also affect the effectiveness of nerve block. In adult studies, the amount of local anesthetic used at each puncture site ranged from 2 to 5 ml. Few studies have been conducted to investigate the amount of local anesthetic in pediatrics, and the amount of local anesthetic is often reduced to avoid the risk of local anesthetic toxicity, which may also compromise the efficacy and duration of the nerve block. In the present study, the children undergoing cranial suture reconstruction were 6-24 months old, and their body weight was very low; thus, the dose of local anesthetic was calculated based on the body weight of each child. The scalp nerves were relatively superficial compared to other nerves, and less local anesthetic was needed. Therefore, the dose of local anesthetic was adjusted based on the body weight according to previously reported methods [