Scalp nerve blockade reduces pain after headframe placement in radiosurgery: a
double blind, randomized clinical trial.
Author(s): Mccormick PJ(1), Osborn IP, Germano IM, Green S, Deiner SG.
Affiliation(s): Author information:
(1)Mount Sinai School of Medicine.
Publication date & source: 2013, Middle East J Anaesthesiol. , 22(1):79-85
BACKGROUND: Patients undergoing stereotactic headframe placement for radiosurgery
report that discomfort associated with the headframe often lasts for the duration
of the treatment day (approximately 6 hours). We hypothesize that blockade of
scalp nerves prior to headframe placement reduces the incidence of moderate to
severe head pain during the entire treatment day. We describe a randomized,
double-blind, placebo-controlled study of awake patients having radiosurgery for
intracranial pathology that examines whether scalp nerve blockade and local
anesthetic infiltration results in superior patient comfort versus infiltration
alone.
METHODS: Twenty seven adult patients undergoing stereotactic radiosurgery were
randomized to receive a nerve block with placebo or bupivacaine 0.5% with
epinephrine. Supraorbital and greater occipital nerve blocks using blinded
syringes were performed by the anesthesiologist in addition to subcutaneous
infiltration of pin sites with lidocaine 1% by the surgeon. Pain was reported
using 10 cm visual analog scales (VAS) at pre-specified time points during the
treatment day. The primary outcome measure was the presence of pain scores
classified as "zero to mild pain (VAS <4)" or "moderate to severe pain (VAS > or
= 4)".
RESULTS: 27 patients were randomized to placebo (n = 14) and nerve block (n = 13)
groups. The proportion of moderate to severe pain measurements were significantly
less in the nerve block group than the placebo group (4.9% vs. 24.1%; odds ratio,
0.166; 95% confidence interval 0.029-0.955; p = 0.044). There were no adverse
events.
CONCLUSION: Scalp nerve block significantly decreased moderate to severe head
pain in radiosurgery patients throughout the treatment day.
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