Objective. The therapeutic effectiveness and safety of occipital nerve blockade (ONB) on occipital neuralgia- (ON-) like acute postcraniotomy headache (ON-APCH) was evaluated. Background. Persistent occipital neuralgia is a subclassification of chronic postcraniotomy headache and has been investigated sporadically in previous publications. The long-lasting neuralgic pain significantly impairs postoperative recovery and quality of life. However, little is known regarding ON-APCH and its management. Methods. All data were retrospectively acquired from consultation records and electronic institutional medical documents. Forty-one patients, who developed drug-resistant ON-APCH after elective craniotomy and received ONB with lidocaine for diagnoses, were included in this study, all of whom were treated using dexamethasone and lidocaine. Pain intensity and ONB correlated complications and side effects were collected and analyzed at three different time points: before ONB, at 1 day after ONB, and at discharge. Results. Nineteen males and twenty-two females aged 49.6 ± 15.2 years were diagnosed with drug-resistant ON-APCH. The mean NRS was 8.0 ± 0.9 before ONB, which later significantly decreased to 2.1 ± 1.4 and 1.6 ± 0.6 at 1 day after ONB and on discharge, respectively. At 1 month after ONB, thirty patients (73%) obtained complete pain relief without medication. At 3 months after ONB, only two (5%) patients had to continue oral medications to maintain pain relief. No adverse effects or complications were observed immediately after, or within 3 months, of the nerve blockade. Conclusions. For drug-resistant ON-APCH, early occipital nerve blockade with dexamethasone and lidocaine is an effective and safe technique, which provides adequate pain relief and may prevent further development of persistent presentation of refractory ON.

中文翻译：

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枕神经阻滞治疗枕神经痛样急性开颅后头痛的回顾性研究

目标。评价了枕神经阻滞（ONB）对枕神经痛-（ON-）像急性开颅后头痛（ON-APCH）的治疗效果和安全性。背景。持续性枕神经痛是慢性开颅手术后头痛的一个亚类，并且在以前的出版物中已经进行了零星的研究。长期的神经痛会严重损害术后恢复和生活质量。但是，关于ON-APCH及其管理知之甚少。方法。所有数据均追溯自咨询记录和电子机构医疗文件。这项研究包括了41名在选择性开颅手术后出现耐药性ON-APCH并接受利多卡因ONB诊断的患者，所有患者均使用地塞米松和利多卡因治疗。在三个不同的时间点收集并分析疼痛强度和与ONB相关的并发症和副作用：ONB前，ONB后1天和出院时。结果。19名男性和22名女性被诊断为耐药ON-APCH，年龄为49.6±15.2岁。ONB前平均NRS为8.0±0.9，随后在ONB后第1天和出院时分别显着下降至2.1±1.4和1.6±0.6。ONB后1个月，有30名患者（73％）无需药物即可完全缓解疼痛。ONB后3个月，只有两名（5％）患者必须继续口服药物以缓解疼痛。在神经阻滞后立即或在3个月内未观察到不良反应或并发症。结论。对于耐药的ON-APCH，地塞米松和利多卡因对枕后神经的早期阻滞是一种有效且安全的技术，可缓解疼痛并可能阻止顽固性ON的持续发作。