Scalp Block for Emergency Craniectomy

Hi everyone, UK resident here. Just a question that I thought of on a night shift. I could find lots of articles for elective craniotomies but not for emergency decompressive craniectomies.

In theory, a decompressive craniectomy is a category 1 emergency so nothing should delay opening the skull and reducing the ICP. However, let’s say for instance, you were able to fit in a scalp block in between all the checks, surgeons scrubbing etc. And it did not delay the surgery at all. Is there any benefit to doing a scalp block?

I understand the patient is not going to be woken up after surgery and will be taken to ICU ventilated. However, my argument for a scalp block would be to reduce anaesthesia requirement (and therefore vasopressor requirement and avoid reductive effects from the anaesthetic on cerebral perfusion) and provide more stability to the blood pressure intraoperatively. The neurosurgeons at our centre don’t seem to have a strong opinion about it either.

No one at our institution does them for emergencies, and I can’t find a specific reason why, other than the patient will not be awake post-operatively and it could cause unnecessary delay. What do you think?