A Comparison of Dexamethasone and Triamcinolone for Ultrasound-guided Occipital C2 Nerve Blocks
| Status: | Recruiting |
|---|---|
| Conditions: | Migraine Headaches |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 8/25/2018 |
| Start Date: | December 2015 |
| End Date: | December 2022 |
| Contact: | Mark C Kendall, MD |
| Email: | m-kendall@northwestern.edu |
| Phone: | 312-695-2528 |
A Comparison of Dexamethasone and Triamcinolone in Combination With Bupivacaine for Ultrasound-guided Occipital C2 Nerve Blocks: A Randomized Controlled Trial
Greater occipital nerve (GON) injection is a commonly performed diagnostic and therapeutic
procedure in headache patients. GON blocks have been shown to be effective in the treatment
of a variety of headaches including occipital neuralgia, migraine, vascular headache, cluster
headache, cervicogenic headache, and post-concussive headache. Local anesthetic and steroids
have been successfully used for diagnostic and or therapeutic nerve pain such as lumbar
radicultis with great success. Dexamethasone is a water soluble steroid, when combined with
local anesthetic; it may increase the analgesia of block duration relative to its
pharmacokinetics. When compared to dexamethasone, triamcinolone, a particulate steroid has a
slower onset time but may provide anti-inflammatory effects up to several weeks.
Investigators want to investigate to see if there exists a difference in reported pain
intensity using the particulate anti-inflammatory corticosteroid (triamcinolone with
bupivacaine) which may provide a greater reduction in reported pain intensity relief may
allow the patient to undergo fewer interventional procedures.
procedure in headache patients. GON blocks have been shown to be effective in the treatment
of a variety of headaches including occipital neuralgia, migraine, vascular headache, cluster
headache, cervicogenic headache, and post-concussive headache. Local anesthetic and steroids
have been successfully used for diagnostic and or therapeutic nerve pain such as lumbar
radicultis with great success. Dexamethasone is a water soluble steroid, when combined with
local anesthetic; it may increase the analgesia of block duration relative to its
pharmacokinetics. When compared to dexamethasone, triamcinolone, a particulate steroid has a
slower onset time but may provide anti-inflammatory effects up to several weeks.
Investigators want to investigate to see if there exists a difference in reported pain
intensity using the particulate anti-inflammatory corticosteroid (triamcinolone with
bupivacaine) which may provide a greater reduction in reported pain intensity relief may
allow the patient to undergo fewer interventional procedures.
Greater occipital nerve (GON) injection is a commonly performed diagnostic and therapeutic
procedure in headache patients. GON blocks have been shown to be effective in the treatment
of a variety of headaches including occipital neuralgia, migraine, vascular headache, cluster
headache, cervicogenic headache, and post-concussive headache.The GON provides sensory
innervation to the posterior scalp to the vertex of the skull and is known to communicate
with the third occipital nerve and lesser occipital nerve during its ascent at the
occiput.The use of ultrasound guidance to assist with needle placement is becoming
increasingly popular due to real-time visualization of soft tissue and surrounding
vasculature as well as the appearance of bony structures. This imaging tool allows for fine
adjustment of the needle tip and direct observation of the injectate thereby confirming local
anesthetic spread at the targeted area. Local anesthetic and steroids have been successfully
used for diagnostic and or therapeutic nerve pain such as lumbar radicultis with great
success. Dexamethasone is a water soluble steroid, when combined with local anesthetic; it
may increase the analgesia of block duration relative to its pharmacokinetics. When compared
to dexamethasone, triamcinolone, a particulate steroid has a slower onset time but may
provide anti-inflammatory effects up to several weeks. Investigators want to investigate to
see if there exists a difference in reported pain intensity using the particulate
anti-inflammatory corticosteroid (triamcinolone with bupivacaine) which may provide a greater
reduction in reported pain intensity relief may allow the patient to undergo fewer
interventional procedures.
procedure in headache patients. GON blocks have been shown to be effective in the treatment
of a variety of headaches including occipital neuralgia, migraine, vascular headache, cluster
headache, cervicogenic headache, and post-concussive headache.The GON provides sensory
innervation to the posterior scalp to the vertex of the skull and is known to communicate
with the third occipital nerve and lesser occipital nerve during its ascent at the
occiput.The use of ultrasound guidance to assist with needle placement is becoming
increasingly popular due to real-time visualization of soft tissue and surrounding
vasculature as well as the appearance of bony structures. This imaging tool allows for fine
adjustment of the needle tip and direct observation of the injectate thereby confirming local
anesthetic spread at the targeted area. Local anesthetic and steroids have been successfully
used for diagnostic and or therapeutic nerve pain such as lumbar radicultis with great
success. Dexamethasone is a water soluble steroid, when combined with local anesthetic; it
may increase the analgesia of block duration relative to its pharmacokinetics. When compared
to dexamethasone, triamcinolone, a particulate steroid has a slower onset time but may
provide anti-inflammatory effects up to several weeks. Investigators want to investigate to
see if there exists a difference in reported pain intensity using the particulate
anti-inflammatory corticosteroid (triamcinolone with bupivacaine) which may provide a greater
reduction in reported pain intensity relief may allow the patient to undergo fewer
interventional procedures.
Inclusion Criteria:
- All patients, ≥ 18 years of age and under 75 years of age, presenting to the
Northwestern Pain Center with occipital headaches who are scheduled to receive a
ultrasound-guided occipital nerve block will be eligible for the study.
- Extracranial tenderness or Tinel's sign over the occipital nerve
- Poor response to other medical treatments (narcotics, physical therapy)
- Paroxysmal stabbing pain, with or without persistent aching between paroxysms, in the
distribution(s) of the greater, lesser and/or third occipital nerves
- Visual Analog Scale (VAS) score of at least 4 at recent headache occurrence.
Exclusion Criteria:
- Abnormal cranial anatomy
- use of anticoagulants
- local infection
- refusal of or lack of consent
- pregnant patients
- systemic steroid in the last three months, steroid injection of any type in the last
three months
- inability to read
- untreated/inadequately treated psychiatric disorders
- cannot comprehend or complete the questionnaires
- known allergies to local or steroids
We found this trial at
1
site
Chicago, Illinois 60611
Principal Investigator: Antoun Nader, M.D.
Phone: 312-695-2528
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