Improving Throughput, Neurology

Treat and Street Headaches.

Wouldn’t it be great if you could take care of the photophobia, nausea, and headaches (of dealing with another night shift) of a patient with a migraine in under 20 minutes?

The Study:

417 headache patients given a lower cervical paraspinous intramuscular injection with bupivacaine.  Total relief in 65% and partial relief in 20% of patients.  No relief in 14%, and worsening symptoms in 1%. Relief of headache as well as associated symptoms were typically noted within 5 to 10 minutes.

YouTube:

http://www.youtube.com/watch?v=0to5wzftpnM

http://www.youtube.com/watch?v=Ut_vXrDD2hU

http://www.youtube.com/watch?v=2OtDXLUBDLo

My Own Story

I have had good success, probably similar to the 80 – 85% published rate.  I have used it for toothaches, primary headache disorders, and the migraineurs.  I usually use an insulin syringe with lidocaine and use 0.25cc for pretreatment on either side as our shop does not have the spray coolant seen in the above videos.  I order meds, do the block, and by the time the nurse steps in for meds, we can figure out if they need anything additional.  Often, they do not, or can take PO meds.

With that said, the only randomized trials for myofascial pain are with spheno-palatine ganglion blocks and show they are not better than placebo. (one looks at chronic myofascial pain & uses lidocaine, the other looks at endoscopic sinus surgery with bupivacaine) Thats not to say that all nerve blocks are a sham – femoral blocks for hip fractures have shown good results over placebo.

Regardless, at an 80 % improvement rate, even if it is placebo effect, I am ok at 80% improvement rate! Next time, instead of waiting an hour for meds to be given, offer it to your patients.  Over 60% of the time they can take discharge papers instead of Compazine.

Special thanks to the SOCMOB blog (socmob.org) who showed up on the #foamed RSS feed with this a few months ago and gave me the inspiration to begin doing these.

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Sphenopalatine ganglion block for the treatment of myofascial pain of the head, neck, and shoulders. PMID: 9552776

The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. PMID :22287376

A comparison of pre-operative nerve stimulator-guided femoral nerve block and fascia iliaca compartment block in patients with a femoral neck fracture. PMID: 23789738

Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. PMID: 17040341

http://www.epmonthly.com/clinical-skills/emrap/how-to-use-paraspinous-injections-for-complex-headaches/

http://socmob.org/2014/01/paraspinous-cervical-block-headache/

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