Up to 30% of patients undergoing intracranial surgery present moderate to severe pain. In this type of surgery, the restriction of the pharmacopoeia, which goes against the concept of multimodal analgesia, results in the important use of opioids not without consequences in terms of complications. Numerous studies have highlighted the benefits of scalp blocks in postoperative pain. The originality of this study lies firstly in the fact that the scalp blocks will be guided by ultrasound and secondly, the incidence of severe pain after scalp blocks will be evaluated
Patient managed in the neurosurgical unit for supratentorial intracranial surgery.
Person affiliated or beneficiary of a social security plan.
Free, informed, and written consent signed by the participant and the investigating physician (at the latest on the day of inclusion and before any examination required by the research).
Surgical procedure under awake surgery (systematic realization of scalp blocks necessary)
Aphasia of comprehension preoperatively or expected postoperatively or any other neurological impairment making self-evaluation of pain impossible.
Contraindication to the use of local anesthetics: allergy or history of intoxication to local anesthetics
Contraindication to adrenaline infiltration: severe ventricular rhythm disorders, severe obstructive cardiomyopathy, unstable coronary insufficiency, hypersensitivity to adrenaline.
Parallel
Echo-guided scalp blocks
DrugClassic anesthetic strategy in association with echo-guided scalp blocks
Classic anesthetic strategy
Drugclassic anesthetic strategy with postoperative analgesia associating Paracetamol and Morphine with standardized dose.
Intense post-operative pain
The primary outcome measure will be a composite outcome including: * Either the need to administer morphine titration at a dose greater than 0.05 mg/kg in the immediate postoperative period (i.e., up to 6 hours after extubation). * Either the presence of severe pain defined by an episode of visual analog scale \> 4 in the immediate postoperative period (i.e., up to 6 hours after extubation).
Absolute pain
Pain will be assessed using a visual analog scale (from 0: no pain to 10: maximum pain).
Morphine consumption.
Recording the amount of morphine consumed
Incidence of Postoperative nausea and vomiting
The occurrence of postoperative nausea and vomiting will be recorded and defined by at least one of the following: * the presence of nausea, * the need to initiate rescue antiemetic treatment, * at least one episode of vomiting.
Chronic post-operative pain
Presence of persistent headache or neuropathic pain at the scar site using a visual analog scale
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