Mellick Larry B, McIlrath S Timothy, Mellick Gary A
Department of Emergency Medicine, Medical Colleg of Georgia, Augusta, GA, USA.
Headache. 2006 Oct;46(9):1441-9. doi: 10.1111/j.1526-4610.2006.00586.x.
The primary objective of this retrospective chart review is to describe 1 year's experience of an academic emergency department (ED) in treating a wide spectrum of headache classifications with intramuscular injections of 0.5% bupivacaine bilateral to the spinous process of the lower cervical vertebrae.
Headache is a common reason that patients present to an ED. While there are a number of effective therapeutic interventions available for the management of headache pain, there clearly remains a need for other treatment options. The intramuscular injection of 1.5 mL of 0.5% bupivacaine bilateral to the sixth or seventh cervical vertebrae has been used to treat headache pain in our facility since July 2002. The clinical setting for the study was an academic ED with an annual volume of over 75,000 patients.
We performed a retrospective review of over 2805 ED patients with the discharge diagnosis of headache and over 771 patients who were coded as having had an anesthetic injection between June 30, 2003 and July 1, 2004. All adult patients who had undergone paraspinous intramuscular injection with bupivacaine for the treatment of their headache were gleaned from these 2 larger databases and were included in this retrospective chart review. A systematic review of the medical records was accomplished for these patients.
Lower cervical paraspinous intramuscular injections with bupivacaine were performed in 417 patients. Complete headache relief occurred in 271 (65.1%) and partial headache relief in 85 patients (20.4%). No significant relief was reported in 57 patients (13.7%) and headache worsening was described in 4 patients (1%). Overall a therapeutic response was reported in 356 of 417 patients (85.4%). Headache relief was typically rapid with many patients reporting complete headache relief in 5 to 10 minutes. Associated signs and symptoms such as nausea, vomiting, photophobia, phonophobia, and allodynia were also commonly relieved.
Our observations suggest that the intramuscular injection of small amounts of 0.5% bupivacaine bilateral to the sixth or seventh cervical spinous process appears to be an effective therapeutic intervention for the treatment of headache pain in the outpatient setting.
本回顾性病历审查的主要目的是描述一家学术性急诊科一年来使用0.5%布比卡因在下颈椎棘突双侧进行肌肉注射治疗多种头痛分类的经验。
头痛是患者前往急诊科就诊的常见原因。虽然有多种有效的治疗干预措施可用于管理头痛疼痛，但显然仍需要其他治疗选择。自2002年7月以来，我们机构一直使用在第六或第七颈椎双侧肌肉注射1.5毫升0.5%布比卡因来治疗头痛疼痛。该研究的临床环境是一家年就诊量超过75000名患者的学术性急诊科。
我们对2805多名出院诊断为头痛的急诊科患者以及2003年6月30日至2004年7月1日期间编码为接受麻醉注射的771多名患者进行了回顾性审查。从这两个较大的数据库中筛选出所有接受过布比卡因椎旁肌肉注射治疗头痛的成年患者，并纳入本次回顾性病历审查。对这些患者的病历进行了系统审查。
417名患者接受了在下颈椎椎旁肌肉注射布比卡因。271名患者（65.1%）头痛完全缓解，85名患者（20.4%）头痛部分缓解。57名患者（13.7%）报告无明显缓解，4名患者（1%）描述头痛加重。总体而言，417名患者中有356名（85.4%）报告有治疗反应。头痛缓解通常很快，许多患者报告在5至10分钟内头痛完全缓解。恶心、呕吐、畏光、畏声和痛觉过敏等相关体征和症状也通常得到缓解。
我们的观察结果表明，在第六或第七颈椎棘突双侧肌肉注射少量0.5%布比卡因似乎是门诊治疗头痛疼痛的一种有效治疗干预措施。
