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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...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove Medical Press
2016
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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 |
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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 |
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