Brain Tumor Res Treat.  2019 Oct;7(2):132-136. 10.14791/btrt.2019.7.e31.

The Effect of Pain Reduction during Headframe Fixation for Stereotactic Radiosurgery by the Preceded Local Anesthesia under the Needle Cap Guidance

• Kim DH
• Cho WH
• Hur BI
• Cha SH
• Lee SW
• Choi CH

• KMID: 2461186
• DOI: http://doi.org/10.14791/btrt.2019.7.e31

Abstract

BACKGROUND
Gamma knife radiosurgery (GKRS) has become a major alternative in the neurosurgical field. However, many patients complained of considerable discomfort during the fixation of rigid headframe. This study investigated whether our modified procedure could reduce fixation-related pain.
METHODS
Sixty-six patients who underwent GKRS were enrolled in this study. Thirty-one patients (Group A) underwent the conventional subcutaneous infiltration technique, and 35 patients (Group B) did the modified procedure. In group A, the headframe was held in position by an assistant, and local anesthetics were injected subcutaneously using a 23-gauge spinal needle at pinning sites. Subsequently, pins were applied according to measurements based on spinal needle depth. In group B, with the frame held in position by an assistant, pin sites were marked with a surgical pen under the guidance of needle cap placed on the pin holes. The head frame was then removed, and local anesthetics were injected subcutaneously and periosteally at each marked pin site using a 26-gauge needle. The headframe was then repositioned 5 minutes after local infiltration, and pins were applied according to measurements based on spinal needle depth. To evaluate pain severity during procedures, visual analogue scale (VAS) scores were recorded during local infiltration and frame placement with pins. The pain scores of the two groups were analyzed statistically.
RESULTS
Group B had a significantly lower VAS score during frame placement than group A (7.26 vs. 3.61; p<0.001), and mean VAS score at local infiltration was also significantly lower in group B (4.74 vs. 3.74; p=0.008).
CONCLUSION
Patients in group B experienced significantly less pain than those in group A during pin placement. Pre-fixation time advanced local anesthesia might reduce pain during stereotactic procedures, and the use of a 26-gauge needle appeared in less pain during local infiltration.

Keyword

Stereotactic radiosurgery; Gamma knife radiosurgery; Pain

MeSH Terms

Anesthesia, Local*
Anesthetics, Local
Head
Humans
Needles*
Radiosurgery*
Anesthetics, Local

Figure

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  Fig. 1 Pin sites were marked with surgical pen under the guidance of needle cap positioned through the pin hole in the frame bar.

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  Fig. 2 Local anesthetic solution was injected periosteally and subcutaneously at each marked pin site using a 26 gauge sharp-beveled needle.

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  Fig. 3 Pin length was measured by spinal needle depth, before applying to the marking sites of patient head.

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  Fig. 4 Anesthetic solution was injected into the periosteal space and formed a bleb-like cyst. 1, medial branch of the supraorbital nerve; 2, lateral branch of the supraorbital nerve.

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  Fig. 5 Anesthetic solution was injected into the periosteal and subcutaneous spaces to anesthetize medial and lateral branches of the supraorbital nerve. 1, medial branch of the supraorbital nerve; 2, lateral branch of the supraorbital nerve.

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