Hernandez Nadia, Guvernator Grace, Ansoanuur George, Ge Michelle, Tabansi Precious, Le Thanh-Thuy, Obeidat Salameh S, de Haan Johanna
Department of Anesthesiology, Division of Regional Anesthesiology and Acute Pain Medicine, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 77030, USA.
Department of Neurology, Division of Trauma, Concussion and Sports Neuromedicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Local Reg Anesth. 2020 Jun 22;13:49-55. doi: 10.2147/LRA.S249250. eCollection 2020.
Intractable headaches can be debilitating, often leading to significant distress, prolonged medical treatment, and unanticipated hospital admissions. There have been significant advances in the treatment of primary intractable headaches such as migraines, tension headaches, and cluster headaches beyond medical management. Treatments may now include interventional strategies such as trigger-point injections, peripheral nerve stimulators, or peripheral nerve and ganglion blocks. There are few studies, however, describing the use of interventional techniques for the management of intractable secondary headaches, including those attributed to injury or infection. A new regional anesthetic technique, the erector spinae plane (ESP) block, was initially used for neuropathic thoracic pain. ESP block has since been reported to provide acute and chronic pain relief of the shoulder, spine, abdomen, pelvis, thorax, and lower extremity. Additionally, there has been one case report to describe the use of the ESP block in the treatment of refractory tension headache. We report four cases of effective analgesia for intractable secondary headache resistant to medical management with high thoracic ESP blocks. In each case, the ESP block provided instant pain relief. We suggest that the findings of this case series indicate that the ESP block may be a useful intervention in patients with severe secondary headache or posterior cervical pain where conventional therapies have limited success, though more studies are necessary.
顽固性头痛可能使人衰弱，常常导致严重困扰、长期药物治疗以及意外住院。在原发性顽固性头痛（如偏头痛、紧张性头痛和丛集性头痛）的治疗方面，除了药物治疗外已经取得了重大进展。现在的治疗方法可能包括介入性策略，如触发点注射、外周神经刺激器或外周神经及神经节阻滞。然而，很少有研究描述介入技术在治疗顽固性继发性头痛（包括由损伤或感染引起的头痛）中的应用。一种新的区域麻醉技术——竖脊肌平面（ESP）阻滞，最初用于治疗神经性胸痛。此后有报道称ESP阻滞可缓解肩部、脊柱、腹部、骨盆、胸部和下肢的急慢性疼痛。此外，有一例病例报告描述了ESP阻滞在治疗难治性紧张性头痛中的应用。我们报告了4例采用高位胸椎ESP阻滞治疗对药物治疗无效的顽固性继发性头痛并取得有效镇痛效果的病例。在每例病例中，ESP阻滞都能立即缓解疼痛。我们认为，该病例系列的研究结果表明，对于传统疗法效果有限的严重继发性头痛或颈后部疼痛患者，ESP阻滞可能是一种有用的干预措施，不过仍需要更多研究。
