From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.
Division of Plastic and Reconstructive Surgery, Weill Cornell Medicine.
Plast Reconstr Surg. 2023 Dec 1;152(6):1319-1327. doi: 10.1097/PRS.0000000000010552. Epub 2023 Apr 13.
Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion.
Pre-NB and post-NB visual analogue pain scores (0 to 10) and duration of NB response were recorded prospectively. Surgical outcomes were recorded prospectively by calculating the Migraine Headache Index (MHI) preoperatively and postoperatively at 3 months, 12 months, and every year thereafter.
The study population included 115 patients. The chance of achieving MHI percentage improvement of 80% or higher was significantly higher in subjects who reported relative pain reduction of greater than 60% following NB versus less than or equal to 60% [63 of 92 (68.5%) versus 10 of 23 (43.5%); P = 0.03]. Patients were more likely to improve their MHI 50% or more with relative pain reduction of greater than 40% versus 40% or less [82 of 104 (78.8%) versus five of 11 (45.5%); P = 0.01]. In subjects with NB response of greater than 15 days, 10 of 13 patients (77.0%) experienced MHI improvement of 80% or greater. Notably, all of these patients (100%) reported MHI improvement of 50% or greater, with mean MHI improvement of 88%. Subjects with a NB response of 24 hours or more achieved significantly better outcomes than patients with a shorter response (72.7% ± 37.0% versus 46.1% ± 39.7%; P = 0.02). However, of 14 patients reporting NB response of less than 24 hours, four patients had MHI improvement of 80% or greater, and seven, of 50% or greater.
Relative pain reduction and duration of NB response are predictors of MHI improvement after headache surgery. NBs are a valuable tool to identify patients who will benefit from surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
专家一致认为，神经阻滞（NB）反应是头痛手术筛选的重要工具。然而，NB 的预测价值仍有待前瞻性证明。
前瞻性记录术前和术后 NB 时的视觉模拟疼痛评分（0 到 10）和 NB 反应持续时间。通过计算偏头痛头痛指数（MHI），前瞻性记录手术结果，术前和术后 3 个月、12 个月及此后每年。
研究人群包括 115 例患者。与 NB 后相对疼痛减轻小于或等于 60%的患者相比，NB 后相对疼痛减轻大于 60%的患者 MHI 百分比改善达到 80%或更高的可能性显著更高[92 例中有 63 例（68.5%），23 例中有 10 例（43.5%）；P=0.03]。与相对疼痛减轻小于或等于 40%的患者相比，相对疼痛减轻大于 40%的患者更有可能将 MHI 改善 50%或更多[104 例中有 82 例（78.8%），11 例中有 5 例（45.5%）；P=0.01]。NB 反应持续时间大于 15 天的患者中，13 例中有 10 例（77.0%）MHI 改善达到 80%或更高。值得注意的是，所有这些患者（100%）的 MHI 改善达到 50%或更高，平均 MHI 改善为 88%。NB 反应持续时间为 24 小时或更长的患者的手术结果显著优于反应时间较短的患者（72.7%±37.0%比 46.1%±39.7%；P=0.02）。然而，在报告 NB 反应小于 24 小时的 14 例患者中，有 4 例患者的 MHI 改善达到 80%或更高，有 7 例患者的 MHI 改善达到 50%或更高。
相对疼痛减轻和 NB 反应持续时间是头痛手术后 MHI 改善的预测指标。NB 是识别受益于手术的患者的有价值的工具。
临床问题/证据水平：风险，III。
