Comparative Effectiveness of Landmark-guided Greater Occipital Nerve (GON) Block at the Superior Nuchal Line Versus Ultrasound-guided GON Block at the Level of C2: A Randomized Clinical Trial (RCT).

Autor:	Kissoon NR; Division of Pain Medicine, Department of Anesthesiology.; Department of Neurology, Mayo Clinic, Rochester, MN., O'Brien TG; Twin Cities Pain Clinic, Edina, MN., Bendel MA; Division of Pain Medicine, Department of Anesthesiology., Eldrige JS; Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Jacksonville, FL., Hagedorn JM; Division of Pain Medicine, Department of Anesthesiology., Mauck WD; Division of Pain Medicine, Department of Anesthesiology., Moeschler SM; Division of Pain Medicine, Department of Anesthesiology., Olatoye OO; Division of Pain Medicine, Department of Anesthesiology., Pittelkow TP; Division of Pain Medicine, Department of Anesthesiology., Watson JC; Division of Pain Medicine, Department of Anesthesiology.; Department of Neurology, Mayo Clinic, Rochester, MN., Pingree MJ; Division of Pain Medicine, Department of Anesthesiology.
Jazyk:	angličtina
Zdroj:	The Clinical journal of pain [Clin J Pain] 2022 Feb 07; Vol. 38 (4), pp. 271-278. Date of Electronic Publication: 2022 Feb 07.
DOI:	10.1097/AJP.0000000000001023
Abstrakt:	Objectives: The purpose of this single center, prospective randomized controlled trial was to compare clinical outcomes between an ultrasound-guided greater occipital nerve block (GONB) at the C2 vertebral level versus landmark-based GONB at the superior nuchal line. Methods: Patients with occipital neuralgia or cervicogenic headache were randomized to receive either a landmark-based GONB with sham ultrasound at the superior nuchal line or ultrasound-guided GONB at the C2 vertebral level with blinding of patients and data analysis investigators. Clinical outcomes were assessed at 30 minutes, 2 weeks, and 4 weeks postinjection. Results: Thirty-two patients were recruited with 16 participants in each group. Despite randomization, the ultrasound-guided GONB group reported higher numeric rating scale (NRS) scores at baseline. Those in the ultrasound-guided GONB group had a significant decrease in NRS from baseline compared with the landmark-based GONB group at 30 minutes (change of NRS of 4.0 vs. 2.0) and 4-week time points (change of NRS of 2.5 vs. -0.5). Both groups were found to have significant decreases in Headache Impact Test-6. The ultrasound-guided GONB had significant improvements in NRS, severe headache days, and analgesic use at 4 weeks when compared with baseline. No serious adverse events occurred in either group. Conclusions: Ultrasound-guided GONBs may provide superior pain reduction at 4 weeks when compared with landmark-based GONBs for patients with occipital neuralgia or cervicogenic headache. Competing Interests: J.M.H. reports personal fees from Abbott, Boston Scientific, and Nevro that are outside of the submitted work. M.J.P. reports participation on WAPMU Board of Directors, but outside the submitted work. N.R.K. serves on the editorial board for Pain Medicine also reports grant from Nevro Corporation and personal fees from UpToDate that are outside the submitted work. The remaining authors declare no conflict of interest. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu