Prolongation of greater occipital neural blockade with 10% lidocaine neurolysis: a case series of a new technique

David Daewhan Kim, Nabil Sibai, David Daewhan Kim, Nabil Sibai

Abstract

Introduction: Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neurolytic effects of GONB with 10% lidocaine can prolong relief.

Methods: After an approval from Henry Ford Hospital Institutional Review Board, a chart review was performed for patients who had GONB with 10% lidocaine. Patients received 10% lidocaine after short response (<1 month / >50% relief) to GONB with 1 cc of a solution containing 9 mL 0.5 % bupivacaine and 40 mg methylprednisolone. They received a block with 10% lidocaine with volume given at <80% of the maximum dose of 4 mg/kg. Injections were performed under fluoroscopic guidance after injection of 0.1 cc of contrast (isovue or magnevist). All patients had intravenous access and were given fentanyl and midazolam. The visual analog scale (VAS) scores were recorded on follow-up, and the duration of response was noted. VAS changes with 10% lidocaine and comparison of duration with methylprednisolone were performed using paired t-test.

Results: Thirteen patients were reviewed; 12 were female and the mean age was 47. Ten were diagnosed with migraine, and three with occipital neuralgia; 12 had bilateral symptoms. Baseline VAS prior to 10% lidocaine averaged 86.92 mm. The mean volume injected per nerve was 1.096 mL. There was significant decrease in mean% VAS with 10% lidocaine at 60.4% (mean: -52.69 mm) (P=0.001). The mean duration of relief was significantly higher with 10% lidocaine at 148.05 days ([standard deviation]=98.87) versus methylprednisolone at 6.33 days (standard deviation=5.01) (P=0.001). No complications or side effects were reported.

Conclusion: Ten percent lidocaine may be a useful neurolytic agent in prolonging the duration of GONB.

Keywords: injections; intractable headaches; migraines; occipital neuralgia; pain relief.

References

    1. Biondi D, Bajwa Z. Cervicogenic headaches. Wolters Kluwer Health; 2007. Available from: .
    1. Olesen J, Steiner TJ. The international classification of headache disorders, 2nd ed. (ICDH-II) J Neurol Neurosurg Psychiatry. 2004;75(6):808–811.
    1. Blumenfeld A, Ashkenazi A, Grosberg B, et al. Patterns of use of peripheral nerve blocks and trigger point injections among headache practitioners in the USA: results of the American headache society interventional procedure survey (AHS-IPS) Headache. 2010;50(6):937–942.
    1. Dilli E, Halker R, Vargas B, Hentz J, Radam T, Rogers R, Dodick D. Occipital nerve block for the short-term preventative treatment of migraine: a randomized, double-blinded placebo-controlled study. Cephalalgia. 2015;35(110):959–968.
    1. Ashkenazi A, Young WB. The effects of greater occipital nerve block and trigger point injection on brush allodynia and pain in migraine. Headache. 2005;45(4):350–354.
    1. Lambru G, Abu Bakr N, Stahlhut L, McCulloch S, Miller S, Shanahan P, Matharu MS. Greater occipital nerve blocks in chronic cluster headache: a prospective open label study. Eur J Neurol. 2014;21(2):338–343.
    1. Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital blockade for cervicogenic headache. Pain Pract. 2006;6(40):278–284.
    1. Piovesan EJ, Kowacs PA, Oshinsky ML. Convergence of cervical and trigeminal sensory afferents. Curr Pain and Headache Rep. 2003;7(5):377–383.
    1. Busch V, Jakob W, Juergens T, Schulte-Mattler W, Kaube H, May A. Functional connectivity between trigeminal and occipital nerves revealed by occipital nerve blockade and nociceptive blink reflexes. Cephalalgia. 2006;26(1):50–55.
    1. Siddiqui F, Caplinger A. Efficacy of greater occipital nerve block with or without bupivacaine in chronic migraineurs. Neurology. 2013;80(7):80–81.
    1. Afridi SK, Shields KG, Bhola R, Goadsby PJ. Greater occipital nerve injection in primary headache syndromes – prolonged effects from a single injection. Pain. 2006;122(1–2):126–129.
    1. Gabrhelík T, Michalek P, Adamus M. Pulsed radiofrequency therapy versus greater occipital nerve block in the management of refractory cervicogenic headache–a pilot study. Prague Med Rep. 2011;112(4):279–287.
    1. Navani A, Mahajan G, Kreis P, Fishman SM. A case of pulsed radiofrequency lesioning for occipital neuralgia. Pain Med. 2006;7(5):453–456.
    1. Gazelka HM, Knievel S, Mauck WD, Moeschler SM, Pingree MJ, Rho RH, Lamer TJ. Incidence of neuropathic pain after radiofrequency denervation of the third occipital nerve. J Pain Res. 2014;7:195–198.
    1. Vu T, Chhatre A. Cooled radiofrequency ablation for bilateral greater occipital neuralgia. Case Rep Neurol Med. 2014;2014:257373.
    1. Hamer JF, Purath TA. Response of cervicogenic headaches and occipital neuralgia to radiofrequency ablation of the C2 dorsal root ganglion and/or occipital nerve. Headache. 2014;54(3):500–510.
    1. Wood KM. The use of phenol as a neurolytic agent: a review. Pain. 1978;5(3):205–229.
    1. Swerlow M. Complications of neurolytic neural blockade. In: Cousins MJ, Bridenbaugh PHO, editors. Neural Blockade and Clinical Management of Pain. Philadelphia: JB Lippincott; 1988. pp. 719–735.
    1. Reid W, Kennedy W, Gray T. Phenol injection of the sympathetic chain. Br J Surg. 1970;57(1):45–50.
    1. Kapur E, Vuckovic I, Dilberovic F, et al. Neurologic and histologic outcome after intraneural injections of lidocaine in canine sciatic nerves. Acta Anaesthesiol Scand. 2007;51(1):101–107.
    1. Hashimoto K, Sakura S, Bollen AW, Ciriales R, Drasner K. Comparative toxicity of glucose and lidocaine administered intrathecally in the rat. Reg Anesth Pain Med. 1998;23(5):444–450.
    1. Kalichman MW, Moorhouse DF, Powell HC, Myers RR. Relative neural toxicity of local anesthetics. J Neuropath Exp Neur. 1993;54(3):234–240.
    1. Kanai Y, Katsuki H, Takasaki M. Graded, irreversible changes in crayfish giant axon as manifestations of lidocaine neurotoxicity. Anesth Analg. 1998;86(3):569–573.
    1. Ready LB, Plumer MH, Haschke RH, Austin E, Sumi SM. Neurotoxicity of intrathecal local anesthetics in Rabbits. Anesthesiology. 1985;63(4):364–370.
    1. Lambert LA, Lambert DH, Strichartz GR. Irreversible conduction block in isolated nerve by high concentrations of local anesthetics. Anesthesiology. 1994;80(5):1082–1093.
    1. Bainton CR, Strichartz GR. Concentration dependence of lidocaine – induced irreversible conduction loss in frog nerve. Anesthesiology. 1994;81(3):657–667.
    1. Lirk P, Flatz M, Haller I, et al. In Zuker diabetic fatty rats, subclinical diabetic neuropathy increases in vivo lidocaine. Reg Anesth Pain Med. 2012;37(6):601–606.
    1. Farber SJ, Saheb-Al-Zamani M, Zieske L, et al. Peripheral nerve injury after local anesthetic injection. Anesth Analg. 2013;117(3):731–739.
    1. Yang S, Abrahams MS, Hurn PD, Grafe MR, Kirsch J. Local anesthetic Schwann cell toxicity is time and concentration dependent. Reg Anesth Pain Med. 2011;36(5):444–451.
    1. Perez-Castro R, Patel S, Garavito-Aguilar ZV, et al. Cytotoxicity of local anesthetics in human neuronal cells. Anesth Analg. 2009;108(3):997–1007.
    1. Myers RR, Heckman HM. Effects of local anesthetics on nerve blood flow: studies using lidocaine with and without epinephrine. Anesthesiology. 1989;71(5):757–762.
    1. Johnson ME, Uhl CB. Toxic elevation of cytoplasmic calcium by high lidocaine in a neuronal cell line. Reg Anesth. 1997;22:A68.
    1. Johnson ME, Uhl CB, Saenz JA, Dasilva AD. Lidocaine is more neurotoxic than bupivacaine, with a different mechanism of cytoplasmic calcium elevation. Reg Anesth. 1998;23:A30.
    1. Schneider M, Ettlin T, Kaufman M, Schumacher P, Urwyler A, Hampl K, von Hochstetter A. Transient neurologic toxicity after hyperbaric subarachnoid anesthesia with 5% lidocaine. Anesth Analg. 1993;76(5):1154–1157.
    1. Choi YK, Liu J. The use of 5% lidocaine for prolonged analgesia in chronic pain patients: a new technique. Reg Anesth Pain Med. 1998;23(1):96–100.
    1. Hempl KF, Schneider, Thorin D, Ummenhofer W, Drewe J. Hyperosmolarity does not contribute to transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine. Reg Anesth. 1995;20(5):363–366.
    1. Kim DD, Asif A, Kataria S. Presentation of neurolytic effect of 10% lidocaine after perineural ultrasound guided injection of a canine sciatic nerve: a pilot study. Korean J Pain. 2016;29(3):158–163.
    1. Keld DB, Hein L, Dalgaard M, Krogh L, Rodt SA. The incidence of transient neurologic symptoms (TNS) after spinal anaesthesia in patients undergoing surgery in the supine position. Hyperbaric lidocaine 5% versus hyperbaric bupivacaine 0.5% Acta Anaesthesiol Scand. 2000;44(3):285–90.
    1. Sahai-Srivastava S, Subhani D. Adverse effect profile of lidocaine injections for occipital nerve block in occipital neuralgia. J Headache Pain. 2010;11(6):519–523.

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