Comparative Effectiveness of Landmark-guided Greater Occipital Nerve (GON) Block at the Superior Nuchal Line Versus Ultrasound-guided GON Block at the Level of C2: A Randomized Clinical Trial (RCT)

• Published in: The Clinical journal of pain Vol. 38; no. 4; pp. 271 - 278
• Main Authors: Kissoon, Narayan R., O’Brien, Travis G., Bendel, Markus A., Eldrige, Jason S., Hagedorn, Jonathan M., Mauck, William D., Moeschler, Susan M., Olatoye, Oludare O., Pittelkow, Thomas P., Watson, James C., Pingree, Matthew J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 07-02-2022
• Subjects: Anesthetics, Local; Headache - diagnostic imaging; Headache - therapy; Humans; Nerve Block; Neuralgia; Post-Traumatic Headache; Ultrasonography, Interventional
• ISSN: 1536-5409; 1536-5409
• DOI: 10.1097/AJP.0000000000001023

The purpose of this single center, prospective randomized controlled trial was to compare clinical outcomes between an ultrasound-guided greater occipital nerve block (GONB) at the C2 vertebral level versus landmark-based GONB at the superior nuchal line.
Patients with occipital neuralgia or cervicogenic headache were randomized to receive either a landmark-based GONB with sham ultrasound at the superior nuchal line or ultrasound-guided GONB at the C2 vertebral level with blinding of patients and data analysis investigators. Clinical outcomes were assessed at 30 minutes, 2 weeks, and 4 weeks postinjection.
Thirty-two patients were recruited with 16 participants in each group. Despite randomization, the ultrasound-guided GONB group reported higher numeric rating scale (NRS) scores at baseline. Those in the ultrasound-guided GONB group had a significant decrease in NRS from baseline compared with the landmark-based GONB group at 30 minutes (change of NRS of 4.0 vs. 2.0) and 4-week time points (change of NRS of 2.5 vs. -0.5). Both groups were found to have significant decreases in Headache Impact Test-6. The ultrasound-guided GONB had significant improvements in NRS, severe headache days, and analgesic use at 4 weeks when compared with baseline. No serious adverse events occurred in either group.
Ultrasound-guided GONBs may provide superior pain reduction at 4 weeks when compared with landmark-based GONBs for patients with occipital neuralgia or cervicogenic headache.