Association of Scalp Nerve Block with Perioperative Outcomes and Postoperative Complications During Subthalamic Nucleus Deep Brain Stimulation: A Single-Center Retrospective Cohort Study.

BACKGROUND

This study aimed to evaluate the effects of the scalp nerve block (SNB) on surgical outcomes and postoperative complications in the subthalamic nucleus (STN) deep brain stimulation (DBS) surgery.

METHODS

This retrospective cohort study analyzed data from 121 adult patients (≥18 years) who underwent STN-DBS surgery at a tertiary teaching hospital in Fuzhou, China, between November 2, 2017, and April 4, 2024. Patients were divided chronologically into two groups: local anesthesia (LA) alone (2017-2020, n=50) and LA combined with SNB (2020-2024, n=71). The primary outcome was the incidence of pulmonary infection within 7 days post-surgery. Secondary outcomes included other complications, microelectrode recordings, and anesthesia and surgery time parameters. Data were analyzed using univariate and multivariate logistic regression.

MAIN

RESULTS

Compared with the LA group, the LA+SNB group had a significantly shorter intracranial electrode implantation duration (123.97 ± 39.76 min vs. 181.74 ± 53.57 min, p < 0.001) and a lower rate of postoperative pulmonary infection (11.3% vs. 32.0%, p = 0.005). In univariate analysis, SNB was associated with a lower risk of pulmonary infection (OR = 0.262, 95% CI: 0.102-0.675, p = 0.006). However, in multivariate analysis adjusting for anesthetic method, duration of DBS, and tracheal extubation time, the association between SNB and pulmonary infection was no longer statistically significant (OR = 0.426, 95% CI: 0.138-1.315, p = 0.138), whereas tracheal extubation time remained an independent predictor (OR = 1.026 per minute, 95% CI: 1.009-1.045, p = 0.004).

CONCLUSION

LA+SNB was associated with improved perioperative outcomes during STN-DBS surgery, including shorter operative time, reduced PACU stay, lower unadjusted pulmonary infection rates, and decreased intracranial air volume. However, only tracheal extubation time, rather than SNB itself, remained an independent predictor of pulmonary infection in multivariate analysis. Temporal confounding and selection bias are inherent limitations.