Gabrhelík T, Michálek P, Adamus M
Department of Anesthesiology and Intensive Care, Faculty of Medicine and Dentistry, Palacký University in Olomouc and University Hospital Olomouc, Czech Republic.
Prague Med Rep. 2011;112(4):279-87.
The aim of this pilot study was to compare the efficacy of pulsed radiofrequency to the greater occipital nerve versus a greater occipital nerve block with a mixture of local anaesthetic and steroid in the management of refractory cervicogenic headache. We enrolled 30 patients suffering from refractory cervicogenic headache. Patients were randomly allocated into two groups of fifteen. A greater occipital nerve block with steroid was utilised in group A, while a pulsed radiofrequency treatment was employed in group B. Success of both procedures was evaluated by comparing pre and post intervention Visual Analogue Scale of pain, Medication Quantification Scale - III. and Global Perceived Effect at three and 9 months after the procedures. At three months post therapy a significant decrease in Visual Analogue Scale (p<0.001) was identified (3.2 points in group A, 3.3 points in group B respectively). In group B pain remained reduced even after 9 months (p<0.001) when compared to pre treatment scores. The consumption of analgesic medication was reduced significantly in both groups at three months (p<0.001) and 9 months (p<0.01), respectively. No serious complication was noted. Greater occipital nerve block is a safe, efficient technique in the management of cervicogenic headaches. Despite the lack of high quality scientific evidence (level III or IV) in the literature, we have extensive experience with steroid application and pulsed radiofrequency to the greater occipital nerve and report the beneficial results in our study.
这项初步研究的目的是比较脉冲射频治疗枕大神经与使用局部麻醉剂和类固醇混合物进行枕大神经阻滞在治疗难治性颈源性头痛方面的疗效。我们招募了30名患有难治性颈源性头痛的患者。患者被随机分为两组,每组15人。A组采用类固醇枕大神经阻滞,而B组采用脉冲射频治疗。通过比较干预前后的视觉模拟疼痛量表、药物量化量表III和治疗后3个月及9个月的整体感知效果来评估两种治疗方法的成功率。治疗后3个月,视觉模拟量表评分显著降低(p<0.001)(A组降低3.2分,B组降低3.3分)。与治疗前评分相比,B组在9个月后疼痛仍持续减轻(p<0.001)。两组在3个月(p<0.001)和9个月(p<0.01)时镇痛药的使用量均显著减少。未观察到严重并发症。枕大神经阻滞是治疗颈源性头痛的一种安全、有效的技术。尽管文献中缺乏高质量的科学证据(III级或IV级),但我们在枕大神经应用类固醇和脉冲射频方面有丰富的经验,并在本研究中报告了有益的结果。