Cargando…

Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique

INTRODUCTION: Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neur...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, David Daewhan, Sibai, Nabil
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047742/
https://www.ncbi.nlm.nih.gov/pubmed/27729811
http://dx.doi.org/10.2147/JPR.S112947
_version_ 1782457472235077632
author Kim, David Daewhan
Sibai, Nabil
author_facet Kim, David Daewhan
Sibai, Nabil
author_sort Kim, David Daewhan
collection PubMed
description INTRODUCTION: Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neurolytic effects of GONB with 10% lidocaine can prolong relief. METHODS: After an approval from Henry Ford Hospital Institutional Review Board, a chart review was performed for patients who had GONB with 10% lidocaine. Patients received 10% lidocaine after short response (<1 month / >50% relief) to GONB with 1 cc of a solution containing 9 mL 0.5 % bupivacaine and 40 mg methylprednisolone. They received a block with 10% lidocaine with volume given at <80% of the maximum dose of 4 mg/kg. Injections were performed under fluoroscopic guidance after injection of 0.1 cc of contrast (isovue or magnevist). All patients had intravenous access and were given fentanyl and midazolam. The visual analog scale (VAS) scores were recorded on follow-up, and the duration of response was noted. VAS changes with 10% lidocaine and comparison of duration with methylprednisolone were performed using paired t-test. RESULTS: Thirteen patients were reviewed; 12 were female and the mean age was 47. Ten were diagnosed with migraine, and three with occipital neuralgia; 12 had bilateral symptoms. Baseline VAS prior to 10% lidocaine averaged 86.92 mm. The mean volume injected per nerve was 1.096 mL. There was significant decrease in mean% VAS with 10% lidocaine at 60.4% (mean: −52.69 mm) (P=0.001). The mean duration of relief was significantly higher with 10% lidocaine at 148.05 days ([standard deviation]=98.87) versus methylprednisolone at 6.33 days (standard deviation=5.01) (P=0.001). No complications or side effects were reported. CONCLUSION: Ten percent lidocaine may be a useful neurolytic agent in prolonging the duration of GONB.
format Online
Article
Text
id pubmed-5047742
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Dove Medical Press
record_format MEDLINE/PubMed
spelling pubmed-50477422016-10-11 Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique Kim, David Daewhan Sibai, Nabil J Pain Res Original Research INTRODUCTION: Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neurolytic effects of GONB with 10% lidocaine can prolong relief. METHODS: After an approval from Henry Ford Hospital Institutional Review Board, a chart review was performed for patients who had GONB with 10% lidocaine. Patients received 10% lidocaine after short response (<1 month / >50% relief) to GONB with 1 cc of a solution containing 9 mL 0.5 % bupivacaine and 40 mg methylprednisolone. They received a block with 10% lidocaine with volume given at <80% of the maximum dose of 4 mg/kg. Injections were performed under fluoroscopic guidance after injection of 0.1 cc of contrast (isovue or magnevist). All patients had intravenous access and were given fentanyl and midazolam. The visual analog scale (VAS) scores were recorded on follow-up, and the duration of response was noted. VAS changes with 10% lidocaine and comparison of duration with methylprednisolone were performed using paired t-test. RESULTS: Thirteen patients were reviewed; 12 were female and the mean age was 47. Ten were diagnosed with migraine, and three with occipital neuralgia; 12 had bilateral symptoms. Baseline VAS prior to 10% lidocaine averaged 86.92 mm. The mean volume injected per nerve was 1.096 mL. There was significant decrease in mean% VAS with 10% lidocaine at 60.4% (mean: −52.69 mm) (P=0.001). The mean duration of relief was significantly higher with 10% lidocaine at 148.05 days ([standard deviation]=98.87) versus methylprednisolone at 6.33 days (standard deviation=5.01) (P=0.001). No complications or side effects were reported. CONCLUSION: Ten percent lidocaine may be a useful neurolytic agent in prolonging the duration of GONB. Dove Medical Press 2016-09-29 /pmc/articles/PMC5047742/ /pubmed/27729811 http://dx.doi.org/10.2147/JPR.S112947 Text en © 2016 Kim and Sibai. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Kim, David Daewhan
Sibai, Nabil
Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title_full Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title_fullStr Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title_full_unstemmed Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title_short Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
title_sort prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047742/
https://www.ncbi.nlm.nih.gov/pubmed/27729811
http://dx.doi.org/10.2147/JPR.S112947
work_keys_str_mv AT kimdaviddaewhan prolongationofgreateroccipitalneuralblockadewith10lidocaineneurolysisacaseseriesofanewtechnique
AT sibainabil prolongationofgreateroccipitalneuralblockadewith10lidocaineneurolysisacaseseriesofanewtechnique