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Great Occipital Nerve Block Using Different Approach

NCT ID: NCT06149299

Last Updated: 2023-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-13

Study Completion Date

2024-06-30

Brief Summary

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Great occipital nerve (GON) block is commonly applied for the pain management of occipital neuralgia, migraine, and cervicogenic headache. The GON orginates from the medial branch of the dorsal ramus of the C2 spinal nerve with variable contribution from the C3 dorsal ramus. After emerging from the suboccipital triangle, the nerve courses cephalad in an oblique trajectory between the semispinalis capitis (SC) and obliqus capitis inferior (OCI) muscles. This area was recognized as a potential location for GON injury. The nerve then passes through the trapezius muscle and courses medial to the occipital artery as it ascends to innervate the posterior scalp.

Many practitioners perform GON injections using a conventional approach, relying solely on superficial bone-based anatomic landmarks to infiltrate local anesthetic and corticosteroid around the nerve at the level of the superior nuchal line.

Some clinicians also use fluoroscopy to confirm the location of bony landmarks. The ambiguity of these injections poses a risk of anesthetizing adjacent structures or injecting into vessels, such as the occipital artery. Very limited research has been done to quantify the risk of these injections, but a complication rate of 5% to 10% has been reported, including headache, dizziness, blurred vision, and syncope.

Ultrasound guidance is increasingly used to mitigate these risks and improve the efficacy of GON injections. Multiple studies have demonstrated successful ultrasound-guided GON blockade at the superior nuchal line and improvement in pain scores compared with nonguided injections.

C2 level GON block using ultrasound targets interfascial plane between OCI and SC muscles. However, a pain physician who begins ultrasound guided injections migth feel very difficult targeting interfascial plane exactly.

Since GON orginiates from deep space of suboccipital triangle, it is expected that injection within OCI muscle might have similar effect with the effect of injection into interfascial plane.

We assume that if the local anesthetics is injected within OCI muscle, the effect of GON block will be generated by the diffusion of injected local anesthetics.

Detailed Description

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Conditions

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Pain, Chronic

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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interfascial plane group

injection into inferfascial plane

Group Type PLACEBO_COMPARATOR

Greater occipital nerve block

Intervention Type PROCEDURE

Greater occipital nerve block using ultrasound guidance

intramuscular group

injection into obliqus capitis inferior muscle

Group Type EXPERIMENTAL

Greater occipital nerve block

Intervention Type PROCEDURE

Greater occipital nerve block using ultrasound guidance

Interventions

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Greater occipital nerve block

Greater occipital nerve block using ultrasound guidance

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Cervicogenic headache
* Migraine
* Occipital neuralgia

Exclusion Criteria

* bilateral headache
* cervical spine surgery within 1 year before
* loss of sensory sensation at the dermatome of GON innervation
* anatomical defect at the region of procedure
* coagulopathy
* pregnancy or breast feeding
* allergy to local anesthetics
Minimum Eligible Age

20 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Keimyung University Dongsan Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Ji Hee Hong

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Hong ji HEE

Daegu, , South Korea

Site Status RECRUITING

Countries

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South Korea

Central Contacts

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Ji H Hong

Role: CONTACT

Phone: +821046794343

Email: [email protected]

Facility Contacts

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J Hee Hong

Role: primary

Other Identifiers

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2023-10-025

Identifier Type: -

Identifier Source: org_study_id