Safety and utility of ultrasound-guided superior cervical ganglion block for headaches and orofacial pain: a retrospective, single-center study of 10 patients.

BACKGROUND: Several new ultrasound-guided superior cervical ganglia blocks (U-SCGBs) have been proposed to overcome the shortcomings of conventional superior cervical ganglia blocks; however, their clinical utility and practicality have not yet been demonstrated. The aim of this study was to evaluate the safety and utility of a new method of U-SCGB. METHODS: We retrospectively collected data on patients who underwent U-SCGB for the treatment of headaches and orofacial pain at a single center. U-SCGB was performed by injecting 2-3 mL of 1% mepivacaine posterior to the internal carotid artery, just above the bifurcation. The Wilcoxon signed-rank test was used to compare pain scores. Numerical data are expressed as the mean ± standard error. RESULTS: The total number of U-SCGB procedures was 43. All procedures were accompanied by Horner's sign. The numerical rating scale score for pain (possible scores, 0-10) was reduced predominantly from 7.0 ± 0.7 before treatment to 4.5 ± 0.7 at the follow-up (p = 0.014). CONCLUSION: U-SCGB was considered a clinically useful and accurate treatment for headaches and orofacial pain in this study.

Cervical selective nerve root injection alleviates chronic refractory pain after brachial plexus avulsion: a case report.

BACKGROUND: Intractable chronic pain, as well as motor, sensory, and autonomic neuropathy, significantly reduces the quality of life of brachial plexus avulsion (BPA) patients. We report the successful application of cervical selective nerve root injection (CSNRI) in a patient with BPA. CASE PRESENTATION: A 40-year-old man had been diagnosed with complete left BPA due to a motorcycle accident and underwent intercostal nerve transplantation at the age of 18 years and had been experiencing pain ever since. His pain increased after fracture of the left humerus, and he was referred to our pain management clinic. As his exacerbated pain was suspected to be due to peripheral nerve hypersensitivity, we performed repetitive ultrasound-guided CSNRI (3 mL of 1% mepivacaine of each) targeted C5 and 6 intervertebral foramina, and his symptoms gradually improved. CONCLUSIONS: Repetitive CSNRI may help diagnose and treat BPA-associated peripheral neuropathic pain, even in patients diagnosed with BPA.