The incidence and degree of pain after craniotomy are generally neglected due to a lack of awareness of postoperative pain and the concern of postoperative adverse reactions of analgesics. In recent decades, with the development of ultrasound, regional anesthesia, especially peripheral nerve block, has entered into the era of visualization, which significantly improves the quality of anesthesia. Consequently, the scalp nerve block has been achieved as the main way of awaking from craniotomy or intraoperative awaking anesthesia. This paper reviews the current situation of analgesia in patients undergoing craniotomy, the anatomy, and ultrasound localization of the scalp nerve, the contraindications and complications of scalp nerve block, which are of great significance in perioperative pain management of craniotomy. Furthermore, a large‑scale of clinical trials with high quality is required to determine the type of local anesthetics for scalp nerve block, the concentration of local anesthetics, the optimal dosage of local anesthetics, the additives of local anesthetics, the combined use of drugs and the duration of analgesic effect.