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Related Experiment Videos

Nerve blocks versus subcutaneous infiltration for stereotactic frame placement.

R Watson1, K Leslie

  • 1The Outcomes Research Group, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia.

Anesthesia and Analgesia
|February 13, 2001
PubMed
Summary

Supraorbital and greater occipital nerve blocks offer a less painful alternative to subcutaneous infiltration for anesthesia during stereotactic head-frame placement in Parkinson's disease surgery. Pain scores were significantly lower during injection with nerve blocks.

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Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Pain Management

Background:

  • Stereotactic head-frame placement is crucial for functional neurosurgery, particularly for Parkinson's disease.
  • Effective anesthesia is essential to minimize patient discomfort during this procedure.

Purpose of the Study:

  • To compare the efficacy and patient-reported pain of supraorbital and greater occipital nerve blocks versus subcutaneous infiltration for head-frame anesthesia.
  • To evaluate pain during local anesthetic injection and stereotactic pin placement.

Main Methods:

  • An unblinded, randomized controlled trial involving 20 Parkinson's disease patients undergoing functional surgery.
  • Each patient served as their own control, receiving nerve blocks on one side and subcutaneous infiltration on the other.

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  • Pain was quantified using Visual Analog Scale (VAS) pain scores (0-100) for injection and pin placement.

    • Main Results:

    • Nerve blocks resulted in significantly lower VAS pain scores during local anesthetic injection compared to subcutaneous infiltration at both frontal (34±24 vs 49±25) and occipital (34±21 vs 49±23) sites.
    • No significant difference in pain was observed between nerve blocks and subcutaneous infiltration for stereotactic pin placement.
    • Supraorbital nerve blocks required more supplementation than greater occipital nerve blocks or subcutaneous infiltration.

    Conclusions:

    • Supraorbital and greater occipital nerve blocks provide a viable, less painful alternative to subcutaneous infiltration for anesthesia during stereotactic head-frame placement.
    • While effective for injection pain, nerve blocks did not show superiority for pin placement pain.
    • Pain scores were highest during initial anesthetic injection and pin placement, decreasing over time.