Background and Purpose: Scalp block is a regional anesthesia technique involving the administration of anesthetic around the scalp nerves for head and neck surgeries and pain management. Two primary methods for performing scalp blocks are ultrasound guidance and anatomical landmarks. This study aimed to compare the success rates of scalp blocks using these two methods, assessing pain absence, anesthesia occurrence during surgery, and complications. Methods: A total of 50 eligible craniotomy candidates were evaluated at Shohadaye Tajrish Hospital over a 6-month period. Patients were divided into two groups: ultrasound-guided block and landmark-guided block. The ultrasound group received blocks under ultrasound guidance, while the landmark group relied on anatomical landmarks for block administration. Both groups were administered a scalp nerve block with 0.5% ropivacaine prior to surgery. Findings: The overall success rate of scalp blocks was higher with ultrasound guidance compared to anatomical landmarks (ultrasound success rate = 72%, landmarks success rate = 24%). However, when analyzing success rates for individual nerves, the differences were not statistically significant (supraorbital P=0.357, supratrochlear 100% success, zygomaticotemporal P=0.977, auriculotemporal P=0.107, occipital major P=0.151, occipital minor P=0.199). No complications were observed in either group. Conclusion: Ultrasound-guided scalp blocks demonstrated a higher success rate than landmark-guided blocks in craniotomy candidates. Further research is recommended to optimize scalp block methods for each nerve, compare drug consumption, and increase sample sizes.