Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery: A Prospective Cohort Study.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 12 2023
01 12 2023
Historique:
medline:
30
11
2023
pubmed:
18
4
2023
entrez:
17
4
2023
Statut:
ppublish
Résumé
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. Risk, III.
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
Identifiants
pubmed: 37067978
doi: 10.1097/PRS.0000000000010552
pii: 00006534-990000000-01752
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1319-1327Informations de copyright
Copyright © 2023 by the American Society of Plastic Surgeons.
Références
Ortiz R, Gfrerer L, Hansdorfer MA, Tsui J, Nealon KP, Austen WG Jr. A pain in the neck? Migraine surgery in patients with prior head or neck injury. Plast Reconstr Surg Glob Open 2019;7:59–60.
Gfrerer L, Austen W Jr, Janis J. Migraine surgery. Plast Reconstr Surg Glob Open 2019;7:e2291.
Guyuron B, Nahabet E, Khansa I, Reed D, Janis JE. The current means for detection of migraine headache trigger sites. Plast Reconstr Surg. 2015;136:860–867.
Rangwani SM, Hehr JC, Janis JE. Clinical effectiveness of peripheral nerve blocks for diagnosis of migraine trigger points. Plast Reconstr Surg. 2021;148:992e–1000e.
Gfrerer L, Dayan E, Austen WG Jr. Trigger-site deactivation surgery for nerve compression headaches. Plast Reconstr Surg. 2021;147:1004e–1021e.
Gfrerer L, Hansdorfer MA, Ortiz R, et al. Patient pain sketches can predict surgical outcomes in trigger-site deactivation surgery for headaches. Plast Reconstr Surg. 2020;146:863–871.
Chartier C, Gfrerer L, Austen WG Jr. Ultrasonographic evidence of trapezius fascia thickening in patients undergoing trigger site deactivation surgery for headaches compared to healthy matched control. Paper presented at: Plastic Surgery The Meeting 2020: Virtual Meeting of the American Society of Plastic Surgeons; October 16 through 18, 2020.
Gfrerer L, Austen WG Jr, Janis JE. Migraine surgery. Plast Reconstr Surg Glob Open 2019;7:e2291.
Guyuron B, Riazi H, Long T, Wirtz E. Use of a Doppler signal to confirm migraine headache trigger sites. Plast Reconstr Surg. 2015;135:1109–1112.
Pourtaheri N, Guyuron B. Computerized tomographic evaluation of supraorbital notches and foramen in patients with frontal migraine headaches and correlation with clinical symptoms. J Plast Reconstr Aesthet Surg. 2018;71:840–846.
Lee M, Erickson C, Guyuron B. Intranasal pathology in the migraine surgery population: incidence, patterns, and predictors of surgical success. Plast Reconstr Surg. 2017;139:184–189.
Guyuron B, Kriegler JS, Davis J, Amini SB. Comprehensive surgical treatment of migraine headaches. Plast Reconstr Surg. 2005;115:1–9.
Janis JE, Barker JC, Palettas M. Targeted peripheral nerve-directed onabotulinumtoxin A injection for effective long-term therapy for migraine headache. Plast Reconstr Surg Glob Open 2017;5:e1270.
Lee M, Monson MA, Liu MT, Reed D, Guyuron B. Positive botulinum toxin type a response is a prognosticator for migraine surgery success. Plast Reconstr Surg. 2013;131:751–757.
Liu MT, Armijo BS, Guyuron B. A comparison of outcome of surgical treatment of migraine headaches using a constellation of symptoms versus botulinum toxin type A to identify the trigger sites. Plast Reconstr Surg. 2012;129:413–419.
Faber C, Garcia RM, Davis J, Guyuron B. A socioeconomic analysis of surgical treatment of migraine headaches. Plast Reconstr Surg. 2012;129:871–877.
Becker WJ. Botulinum toxin in the treatment of headache. Toxins (Basel) 2020;12:803.
Schoenbrunner AR, Khansa I, Janis JE. Cost-effectiveness of long-term, targeted onabotulinumtoxinA versus peripheral trigger site deactivation surgery for the treatment of refractory migraine headaches. Plast Reconstr Surg. 2020;145:401e–406e.
Liu MT, Armijo BS, Guyuron B. A comparison of outcome of surgical treatment of migraine headaches using a constellation of symptoms versus botulinum toxin type A to identify the trigger sites. Plast Reconstr Surg. 2012;129:413–419.
Dilli E, Halker R, Vargas B, et al. Occipital nerve block for the short-term preventive treatment of migraine: a randomized, double-blinded, placebo-controlled study. Cephalalgia 2015;35:959–968.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
Ashkenazi A, Matro R, Shaw JW, Abbas MA, Silberstein SD. Greater occipital nerve block using local anaesthetics alone or with triamcinolone for transformed migraine: a randomised comparative study. J Neurol Neurosurg Psychiatry 2008;79:415–417.
Kashipazha D, Nakhostin-Mortazavi A, Mohammadianinejad SE, Bahadoram M, Zandifar S, Tarahomi S. Preventive effect of greater occipital nerve block on severity and frequency of migraine headache. Glob J Health Sci. 2014;6:209–213.
Ammar AS, Mahmoud KM. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: a prospective randomized controlled trial. Saudi J Anaesth. 2012;6:229–233.
Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg. 2006;102:263–267.
Reddy PD, Zelicof SB, Ruotolo C, Holder J. Interdigital neuroma. Local cutaneous changes after corticosteroid injection. Clin Orthop Relat Res. 1995;317:185–187.
Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 2003;4:407–414.
Allen SM, Mookadam F, Cha SS, Freeman JA, Starling AJ, Mookadam M. Greater occipital nerve block for acute treatment of migraine headache: a large retrospective cohort study. J Am Board Fam Med. 2018;31:211–218.
Gfrerer L, Hulsen JH, McLeod MD, Wright EJ, Austen WG Jr. Migraine surgery: an all or nothing phenomenon? Prospective evaluation of surgical outcomes. Ann Surg. 2019;269:994–999.
Shauly O, Gould DJ, Sahai-Srivastava S, Patel KM. Greater occipital nerve block for the treatment of chronic migraine headaches: a systematic review and meta-analysis. Plast Reconstr Surg. 2019;144:943–952.
Childs JD, Piva SR, Fritz JM. Responsiveness of the numeric pain rating scale in patients with low back pain. Spine (Phila Pa 1976) 2005;30:1331–1334.
Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole MR. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94:149–158.
Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;165:129–133.
Dilli E, Halker R, Vargas B, et al. Occipital nerve block for the short-term preventive treatment of migraine: a randomized, double-blinded, placebo-controlled study. Cephalalgia 2015;35:959–968.
Brandt RB, Doesborg PGG, Meilof R, et al. Repeated greater occipital nerve injections with corticosteroids in medically intractable chronic cluster headache: a retrospective study. Neurol Sci. 2021;43:1267–1272.
Chowdhury D, Datta D, Mundra A. Role of greater occipital nerve block in headache disorders: a narrative review. Neurol India 2021;69:S228–S256.
Vimont A, Leleu H, Durand-Zaleski I. Machine learning versus regression modelling in predicting individual healthcare costs from a representative sample of the nationwide claims database in France. Eur J Health Econ. 2022;23:211–223.
Zhang H, Yang X, Lin Y, Chen L, Ye H. The efficacy of greater occipital nerve block for the treatment of migraine: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;165:129–133.
Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: a systematic review and meta-analysis. Am J Emerg Med. 2017;35:1750–1754.
Evans AG, Hill DS, Grush AE, et al. Outcomes of surgical treatment of migraines: a systematic review & meta-analysis. Plast Surg (Oakv.) 2021;31:192–205.
Blumenfeld A, Ashkenazi A, Napchan U, et al. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches—a narrative review. Headache 2013;53:437–446.
Ashkenazi A, Levin M. Greater occipital nerve block for migraine and other headaches: is it useful? Curr Pain Headache Rep. 2007;11:231–235.