超声引导下C2水平枕大神经联合阻滞、斜方肌触发点注射及眶上-滑车上神经阻滞：对慢性偏头痛的异常性疼痛和功能障碍更有效
Ultrasound-Guided Combined Greater Occipital Nerve Block at the C2 Level with Trapezius Trigger Point Injection and Supraorbital-Supratrochlear Nerve Block: More Effective on Allodynia and Disability in Chronic Migraine.
作者信息
Turan Suna Aşkın, Aydın Şenay, Gözükara Melih G, Çabalar Murat
机构信息
Department of Pain, Basaksehir Cam and Sakura City Hospital, University of Health Sciences, İstanbul.
Department of Neurology, Yedikule Chest Disease and Surgery Training and Research Hospital, University of Health Sciences, Istanbul.
出版信息
Ann Indian Acad Neurol. 2023 Nov-Dec;26(6):943-951. doi: 10.4103/aian.aian_677_23. Epub 2023 Dec 15.
BACKGROUND
Chronic migraine (CM) patients with cutaneous allodynia (CA) show a poor response to treatment. Long-term studies have yet to be conducted to demonstrate the efficacy of blocks on CA. This study evaluated the improvement in allodynia and disability in CM treated with ultrasound (US)-guided blocks.
METHODS
In this prospective, non-randomized comparative study, 60 CM patients with CA were evaluated for the clinical effectiveness of the therapy using the numeric rating scale (NRS), headache impact test-6 (HIT-6), brush allodynia test, and allodynia symptom checklist (ASC-12). At the first visit, tenderness in the nerve or trapezius muscle was confirmed in the intervention group. US-guided greater occipital nerve block (GONB), GONB, and trapezius muscle injection (TPI), or GONB, TPI, and peripheral trigeminal nerve block (PTNB), respectively, were performed four times once a week for a month. Initial and third-month assessments were performed.
RESULTS
The ASC-12 scores decreased in the GONB+TPI+PTNB and GONB groups more than the GONB+TPI group (mean rank, respectively, 26.86, 27.40, 38.39; = 0.018). The decrease in HIT-6 scores was greater in the GONB+TPI+PTNB group than in the GONB group (mean rank, respectively, 21.98, 39.95, < 0.017) in the first month. In the third month, the GONB+TPI+PTNB group scored HIT-6 significantly lower than GONB and GONB+TPI (mean rank: 18.84, 38.73, 35.61; < 0.001).
CONCLUSIONS
GONB+TPI+PTNB was more successful in alleviating allodynia and disability.
背景
患有皮肤超敏反应（CA）的慢性偏头痛（CM）患者对治疗反应不佳。尚未进行长期研究来证明阻滞对CA的疗效。本研究评估了超声（US）引导下阻滞治疗CM时超敏反应和功能障碍的改善情况。
方法
在这项前瞻性、非随机对照研究中，使用数字评分量表（NRS）、头痛影响测试-6（HIT-6）、刷状超敏反应测试和超敏反应症状清单（ASC-12）对60例患有CA的CM患者进行治疗的临床疗效评估。在首次就诊时，干预组确认神经或斜方肌有压痛。分别进行超声引导下枕大神经阻滞（GONB）、GONB和斜方肌注射（TPI），或GONB、TPI和外周三叉神经阻滞（PTNB），每周一次，共进行四次，持续一个月。进行初始和第三个月的评估。
结果
GONB+TPI+PTNB组和GONB组的ASC-12评分下降幅度大于GONB+TPI组（平均秩次分别为26.86、27.40、38.39；P = 0.018）。第一个月，GONB+TPI+PTNB组的HIT-6评分下降幅度大于GONB组（平均秩次分别为21.98、39.95，P < 0.017）。在第三个月，GONB+TPI+PTNB组的HIT-6评分显著低于GONB组和GONB+TPI组（平均秩次：18.84、38.73、35.61；P < 0.001）。
结论
GONB+TPI+PTNB在减轻超敏反应和功能障碍方面更成功。
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