Objective: The analgesia nociception index (ANI) is derived from the sympatho-vagal balance variability in heart rhythm induced by surgical stimulus and reflects the analgesia/nociception balance during general anesthesia. Intraoperative titration of opioids and evaluation of the response to noxius stimuli in patients undergoing craniotomy gain importance. In this retrospective study, it was aimed to evaluate the effectiveness of ANI in patients who underwent elective craniotomy with scalp block under target-controlled total intravenous anesthesia and to investigate its relationship with hemodynamic parameters and bispectral index (BIS). Material and Methods: Following approval of the ethics committee, anesthesia records of patients who underwent elective supratentorial craniotomy from January 2019-May 2019 were retrospectively reviewed. As a result of data scanning, the patients were divided into two groups as those monitored with ANI (group ANI) and those undergoing standard anesthesia follow-up (group control). Hemodynamic data, BIS, ANI (group ANI), duration of anesthesia and surgery, extubation time and consumed remifentanil were scanned. Results: Demographic data, intraoperative data, duration of anesthesia and surgery, mean BIS values, extubation time were similar for both groups. There was no difference between the two groups in the consumption of remifentanil (group control=1.875±422 μg, group ANI=1.786±238 μg, p=0.32). A significant inverse correlation was found between heart rate and mean arterial pressure and ANI (p<0.0001). There was no statistically significant correlation between the BIS and ANI (p=0.758). Conclusion: In patients who underwent elective craniotomy with scalp block, administration of remifentanil under the guidance of intraoperative ANI monitoring provided objective intraoperative analgesia management.