Ultrasound-Guided versus Fluoroscopy-Guided Deep Cervical Plexus Block for the Treatment of Cervicogenic Headache

Abstract

Objective. The aim of this study was to compare the efficacy of ultrasound-guided deep cervical plexus block with fluoroscopy-guided deep cervical plexus block for patients with cervicogenic headache (CeH). Methods. A total of 56 patients with CeH were recruited and randomly assigned to either the ultrasound-guided (US) or the fluoroscopy-guided (FL) injection group. A mixture of 2–4 mL 1% lidocaine and 7 mg betamethasone was injected along C2 and/or C3 transverse process. The measurement of pain was evaluated by patients' ratings of a 10-point numerical pain scale (NPS) before and 2 wks, 12 wks, and 24 wks after treatments. Results. The blocking procedures were well tolerated. The pain intensity, as measured by NPS, significantly decreased at 2 wks after injection treatment in both US and FL groups, respectively, compared with that of baseline (P < 0.05). The blocking procedures had continued, and comparable pain relieving effects appeared at 12 wks and 24 wks after treatment in both US and FL groups. There were no significant differences observed in the NPS before and 2 wks, 12 wks, and 24 wks after treatment between US and FL groups. Conclusions. The US-guided approach showed similar satisfactory effect as the FL-guided block. Ultrasonography can be an alternative method for its convenience and efficacy in deep cervical plexus block for CeH patients without radiation exposure.

Cervical plexus block

“…Furthermore, if ansa cervicalis also has an afferent neuronal composite [ 50 ], the deep CPB would have more clinical significance in treating postoperative pain after neck surgeries involving the infrahyoid and/or SCM muscles, or pain originating in the neck. Wan et al [ 56 ] and Goldberg et al [ 57 ] reported that deep CPBs at the C2 or C3 transverse process could treat cervicogenic headaches effectively. The deep CPB has also been applied during thyroid or parathyroid surgery [ 58 , 59 ], oral and maxillofacial surgery [ 3 ], and CEA [60–64] to obtain adequate anesthesia and/or analgesia.…”

“…Deep CPBs can produce major complications such as intravascular injection, epidural or subarachnoid injection, and phrenic nerve palsy, due to its deep endpoint [ 12 , 65 ]; however, with the introduction of ultrasound, the deep CPB has become a relatively safe and simple procedure [ 3 , 42 , 66 , 67 ]. For the ultrasound-guided (USG) deep CPB, Perisanidis et al [ 3 ] and Saranteas et al [ 67 ] simply injected local anesthetics into the space between the prevertebral fascia and the cervical transverse process under ultrasound guidance, but Wan et al [ 56 ] and Sandeman et al [ 66 ] injected local anesthetics after the needle touched the target cervical transverse process under ultrasound guidance.…”

Efficacy of interventional treatment strategies for managing patients with cervicogenic headache: a systematic review

“…A randomized controlled study by Goldberg et al [ 21 ] and non-randomized study by Wan et al [ 22 ] demonstrated effective pain relief following deep cervical plexus block. A retrospective study by He et al [ 23 ] showed significant pain reduction following continuous cervical epidural block for at least 6 months in CeH patients.…”

“…The injection effectiveness was rated at 42% effective for all first injections and 40% effective for the last injection. Wan et al [ 22 ] evaluated 56 patients who underwent either an ultrasound-guided or fluoroscopic-guided deep cervical plexus block along the C2 and/or C3 transverse process and reported a significant decrease in pain intensity (NRS) in both groups at 2, 12, and 24 weeks post-injection, with no significant differences observed between the groups. However, the small sample size and lack of double-blinding limited the strength of these findings and a clear understanding of the role of this treatment for CeH management [ 21 , 22 ].…”

Ultrasound-Guided Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar Disc Herniation: A Prospective, Randomized, Controlled Study

“…In this investigation, sonography was used to guide transforaminal PRP and steroid injection. The outcomes of nerve root block under the guidance of sonography have proven to be similar to those of injections being guided by either computed tomography scan or X-ray [ 34 – 36 ]. Furthermore, sonography provides the advantages of real-time and dynamic observation with high accuracy, safe, convenient, no radiation, and avoidance of nerve or vessel injury.…”