Meticulous aortic replacement is the cornerstone of emergency aortic dissection and the provision of sufficient cerebral protection and pain control during aortic repair is a major challenge. The standard technique for brain protection in aortic arch replacement is still controversial. Previous studies show that bilateral selective antegrade cerebral perfusion can save operation time in arch repair, cause less neurological dysfunction, and achieve better pain control after surgery. This article reviews the special operative protocols, selective analgesics, advantages, and the risks involved in separated graft technique and selective antegrade cerebral perfusion in this painful vascular disorder.