Scalp nerve blockade reduces pain after headframe placement in radiosurgery: A double blind, randomized clinical trial

Patrick J. Mccormick, Irene P. Osborn, Isabelle M. Germano, Sheryl Green, Stacie G. Deiner

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 ≥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.

Original languageEnglish (US)
Pages (from-to)79-86
Number of pages8
JournalMiddle East Journal of Anesthesiology
Volume22
Issue number1
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Radiosurgery
Nerve Block
Scalp
Randomized Controlled Trials
Pain
Pain Measurement
Placebos
Headache
Bupivacaine
Syringes
Therapeutics
Lidocaine
Local Anesthetics
Visual Analog Scale
Epinephrine
Odds Ratio
Outcome Assessment (Health Care)
Confidence Intervals
Pathology
Incidence

Keywords

  • Bupivacaine
  • Nerve block
  • Randomized controlled trial
  • Regional anesthesia
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Scalp nerve blockade reduces pain after headframe placement in radiosurgery : A double blind, randomized clinical trial. / Mccormick, Patrick J.; Osborn, Irene P.; Germano, Isabelle M.; Green, Sheryl; Deiner, Stacie G.

In: Middle East Journal of Anesthesiology, Vol. 22, No. 1, 02.2013, p. 79-86.

Research output: Contribution to journalArticle

Mccormick, Patrick J. ; Osborn, Irene P. ; Germano, Isabelle M. ; Green, Sheryl ; Deiner, Stacie G. / Scalp nerve blockade reduces pain after headframe placement in radiosurgery : A double blind, randomized clinical trial. In: Middle East Journal of Anesthesiology. 2013 ; Vol. 22, No. 1. pp. 79-86.
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abstract = "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 ≥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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