• Philipp Krauss, Natalia Athanasia Marahori, Markus Florian Oertel, Florian Barth, and Lennart Henning Stieglitz.
• Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland. Electronic address: ph.krauss@gmx.de.
• World Neurosurg. 2018 Dec 1; 120: e991-e999.

ObjectiveIn deep brain stimulation (DBS) surgery, acute high blood pressure (BP) is a risk factor for intracranial hemorrhage. To minimize pain and hypertensive conditions, sufficient local anesthesia is mandatory. We evaluated whether local instillation of anesthetics (LA) or a scalp block (SB) is superior concerning intraoperative hemodynamics and analgesia.MethodsWe retrospectively analyzed intraoperative cardiovascular parameters and perioperative medication in 47 patients (LA = 29, SB = 18) undergoing DBS surgery. Primary study end points were intraoperative systolic BP and heart rate. Secondary end points were use of intraoperative antihypertensives and perioperative analgesics.ResultsPatients who had SB showed lower mean systolic BP and heart rate compared with patients who had LA. Patients who had LA required more antihypertensive medication to stabilize BP. BP was higher, particularly during the first 90 minutes of surgery, in patients who had LA. Thereafter, more antihypertensives were necessary to achieve sufficient BP control in the LA group. The dose of analgesics did not differ significantly between both groups during and after surgery.ConclusionsOur data suggest that SB might be superior to LA for DBS surgery with respect to BP control and hemodynamics. The need for analgesics does not differ substantially between both anesthetic treatment options.Copyright © 2018 Elsevier Inc. All rights reserved.

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