Objective — to study the peculiarities of analgesia in patients after craniotomy performed under of combined endotracheal anesthesia and blockade of nerves. Material and methods. A simple blind, prospective, randomized study was performed. 51 patients were operated on for injuries of head or brain tumors, postoperative skull defect. Three groups were formed. Group 1 included 19 patients with general anesthesia and nerve blocks of the scalp. Group 2 included 17 patients with general anesthesia. Patients of groups 1 and 2 were in clear consciousness. Group 3 included 15 unconscious patients. Patients in Group 3 underwent general anesthesia or general anesthesia with nerve blocks of the scalp. General anesthesia was total intravenous (propofol) with mechanical ventilation. Blockade of nerves produced 0.5% bupivacaine or 0.75—1.0% ropivacaine. Pain in patients in groups 1 and 2 was assessed 2, 10—12 hours after operation with a linear visual analogue scale. The patients were postoperatively anesthetized with narcotic and non-narcotic drugs. Results. In patients of group 1, pain after 2 hours after operation was 0.8±0.4 points; in 10—12 hours — 2.3±1.2 points. In patients of Group 2, pain after 2 hours was 3.0±2.1 points; in 10—12 hours — 3.9±1.6 points. 7 patients of group 1 and one patient of group 2 refused analgesia in the first day after craniotomy. The use of ketorolac in group 1 patient was 30 mg/day, in group 2 was 60 mg/day. Consciousness in patients of group 3 after the operation was absent. Patients of group 3 were anesthetized with titration of narcotic drugs and injections of NSAIDs. Conclusion. Patients with general anesthesia and nerve blocks of the scalp, in the first day after the operation, noted less pain and have taken less ketorolac than patients with general anesthesia.