Scalp local anesthesia

For larger tumors, multiple tumors, and tumors in areas where it may be difficult to apply sufficient local anesthesia (e.g., periost involvement in the scalp), general anesthesia is recommended. This may be handled by short-acting anesthetic agents such as propofol combined with short-acting opioids [15]. As pulses should be administered within approximately a 20 min window, the anesthesia can be short and the pahent discharged on the same day [9]. 

In scalp-reduction surgery, hyaluronidase lias been combined with die local anesthetics to facilitate their diffusion, to enhance the anesthesia, and to ease the dissection [124]. 

Field block anesthesia is produced by subcutaneous injection of a solution of local anesthetic in order to anesthetize the region distal to the injection. For example, subcutaneous infiltration of the proximal portion of the volar surface of the forearm results in an extensive area of cutaneous anesthesia that starts 2-3 cm distal to the site of injection. The same principle can be applied with particular benefit to the scalp, the anterior abdominal wall, and the lower extremity. The drugs, concentrations, and doses recommended are the same as for infiltration anesthesia. The advantage of field block anesthesia is that less drug can be used to provide a greater area of anesthesia than when infiltration anesthesia is used. 

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