Nerve Blocks Versus Subcutaneous Infiltration for Stereotactic Frame Placement

In this unblinded, randomized controlled trial, we compared supraorbital and greater occipital nerve blocks with subcutaneous infiltration for anesthesia during the placement of a stereotactic head-frame. Twenty consecutive patients scheduled for functional surgery to treat Parkinson’s disease were studied. Each patient received supraorbital and greater occipital nerve blocks on one side of the head and subcutaneous infiltration on the other, thereby acting as their own control. Pain was assessed by visual analog scale pain scores (scale: 0–100) for both local anesthetic injection and stereotactic pin placement. Supplementary subcutaneous infiltration was also recorded. Results are presented as mean ± sd. Nerve blocks were significantly less painful than subcutaneous infiltration of local anesthetic at both the frontal (34 ± 24 vs 49 ± 25) and occipital (34 ± 21 vs 49 ± 23) sites. Neither technique was superior in preventing pain associated with pin placement, at either the frontal site (48 ± 27 vs 46 ± 24) or occipital site (33 ± 27 vs 32 ± 24). Supraorbital nerve blocks required significantly more supplementation than either greater occipital nerve blocks or subcutaneous infiltration. Visual analog scale pain scores were greater at local anesthetic injection and pin placement than at any subsequent time. We conclude that supraorbital and greater occipital nerve blocks are an alternative to subcutaneous infiltration for the placement of a stereotactic frame. Implications Supraorbital and greater occipital nerve blocks represent an effective alternative to subcutaneous infiltration for placement of a stereotactic head-frame. With the techniques used in our study, nerve blocks were less painful than subcutaneous infiltration.