Comparison of Targeted Scalp Block Versus Local Infiltration on Awake Deep Brain Stimulation Surgery

BOSSAKARA SOKHOM, HEIDI YOUNG, HANWOOL CHOI

VIRGINIA MASON FRANCISCAN HEALTH

Introduction

● Deep brain stimulation (DBS) surgery is primarily used to treat movement

disorders.

● Unique anesthetic technique is needed for patient to be sedated and tolerate

rigid headframe placement while able to respond to verbal questioning during

surgical exposure.

● Tight hemodynamic control is paramount in order to avoid complications such

as subarachnoid hemorrhage.

● We aim to compare the effectiveness of the use of local anesthetic by the

surgical team versus a targeted preoperative scalp block by anesthesia

providers in the first stage of DBS surgery.

Materials and Methods

● IRB approval was obtained for a retrospective chart review of previous DBS

stage 1 cases from December 1st

, 2020 to March 1st, 2023.

● Consents obtained as part of anesthesia and surgical consent for procedure.

● 54 cases identified, with 27 from the local anesthetic group (LA) and 27 from

the scalp block group (SB).

● Scalp block was performed preoperatively in the induction area following a

standard protocol with a total of 16mL of 0.5% bupivacaine. See Figure 1.

● LA group was administered local anesthetic at the pinning sites by the surgical

team just prior to pinning and headframe placement.

● We manually collected data from the patient’s electronic anesthesia and

medical records and used a two-tailed Welch’s test or Chi square test to test for

significance at p < 0.05.

Results

● Table 1 shows baseline patient characteristics.

● Our retrospective data review does not show any significant differences between the

scalp block group and the non-scalp block group in terms of perioperative opioid

requirement, hemodynamic control or hospital length of stay (Table 2).

Discussions

● We do not observe significant differences in hospital length of stay, opioid

requirement, and antihypertensive medication use between the scalp block

group and those with local anesthetic group.

● However, in other studies, scalp blocks have led to less opioid use, antiemetic

requirement, and overall better patient satisfaction (1-5).

● Results from our study are limited by its retrospective nature, small sample

size, and lack of standardization for intra-op and post-op care relating to

opioid and antihypertensive administration.

● Nonetheless, the pragmatic nature of the anesthetic course in our study

provides important understanding for future randomized, controlled trials to

avoid any potential bias given the variable conclusions in the current

literature.