Department of Day Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Pain Pract. 2023 Jul;23(6):609-617. doi: 10.1111/papr.13224. Epub 2023 Mar 28.
Whether ultrasound-guided stellate ganglion block (SGB) is a valuable therapeutic option for the treatment of patients with chronic migraine (CM) is worth exploring. If SGB is proven to be effective for CM, the identification of potential predictors for the effectiveness of SGB warrants further investigation. This study aimed to investigate the effectiveness and safety of SGB in patients with CM and to explore the predictive factors for its treatment effectiveness.
This is a retrospective observational study. We retrospectively analyzed the effects of SGB for the treatment of patients with CM under ultrasound guidance, between January 2018 and June 2022. The follow-up time was approximately 1 month, 2 months, and 3 months after the last SGBs. The response criterion was defined as a reduction in pain intensity of > 50% measured using the most severe numerical rating scale (NRS) score compared to pretreatment baseline, without an increase in the dose or the type of analgesic or anxiolytic/antidepressant medication, otherwise unresponsive to SGB. Univariable and multivariable analyses were performed to identify the predictive factors for SGB response.
Ninety-seven patients were included in this study. SGB was effective in most of the CM patients, with an effective rate of 90.7%, 82.5%, and 71.1% after 1, 2, and 3 months of the last SGBs, respectively. At 3-month follow-up, 95.7% responsive patients benefited from repeated SGBs. In patients receiving repeated SGB treatments, the number of SGBs in responsive patients was significantly greater than those in patients with no response at 3-month follow-up (3.41 ± 1.31 vs. 2.68 ± 0.67, p = 0.02). Comorbid anxiety or depression was a negative predictor of SGB effectiveness at 3-month follow-up (B = -0.25, 95% CI -0.45 to -0.05, p = 0.01). The overall adverse events rate associated with ultrasound-guided SGB was 9.3%. There were no serious complications; all adverse events were transient, with hoarseness being the most common adverse event.
Ultrasound-guided SGB was an effective and safe treatment for CM patients. The majority of responsive patients with CM benefited from repeated SGBs. CM patients who needed repeated SGBs may obtain good and sustained analgesic effect after receiving a greater number of SGBs. Patients without comorbidities such as anxiety or depression were more likely to benefit from SGB treatments.
超声引导下星状神经节阻滞（SGB）是否是治疗慢性偏头痛（CM）患者的有价值的治疗选择值得探讨。如果 SGB 被证明对 CM 有效，那么确定 SGB 有效性的潜在预测因素就需要进一步研究。本研究旨在探讨 SGB 治疗 CM 患者的有效性和安全性，并探讨其治疗效果的预测因素。
这是一项回顾性观察性研究。我们回顾性分析了 2018 年 1 月至 2022 年 6 月期间，在超声引导下进行 SGB 治疗的 CM 患者的效果。末次 SGB 后约 1、2、3 个月进行随访。反应标准定义为与预处理基线相比，最严重数字评分量表（NRS）评分的疼痛强度降低≥50%，而不增加镇痛药或抗焦虑/抗抑郁药的剂量或类型，否则对 SGB 无反应。进行单变量和多变量分析以确定 SGB 反应的预测因素。
本研究共纳入 97 例患者。SGB 对大多数 CM 患者有效，末次 SGB 后 1、2、3 个月的有效率分别为 90.7%、82.5%和 71.1%。3 个月随访时，95.7%的反应性患者受益于重复 SGB。在接受重复 SGB 治疗的患者中，3 个月随访时反应性患者的 SGB 次数明显多于无反应患者（3.41±1.31 比 2.68±0.67，p=0.02）。合并焦虑或抑郁是 3 个月随访时 SGB 有效性的负预测因素（B=-0.25，95%CI-0.45 至-0.05，p=0.01）。与超声引导下 SGB 相关的总体不良事件发生率为 9.3%。无严重并发症；所有不良事件均为短暂性，声音嘶哑是最常见的不良事件。
超声引导下 SGB 是治疗 CM 患者的一种有效且安全的治疗方法。大多数需要重复 SGB 的反应性 CM 患者都受益于重复 SGB。接受更多 SGB 治疗的 CM 患者可能会获得良好且持续的镇痛效果。无焦虑或抑郁等合并症的患者更有可能从 SGB 治疗中获益。
