Does Bupivacaine Concentration Matter? A Comparative Study of 0.25% and 0.5% Bupivacaine in Greater Occipital Nerve Blocks

Abstract

Objective: This study aimed to assess the effectiveness of two concentrations of bupivacaine (0.25% and 0.5%) in greater occipital nerve (GON) blocks in patients with chronic migraine. Method: In this retrospective analysis, 72 patients with chronic migraine, treated between 2019 and 2021, were divided into two groups: Group 1 (0.25% bupivacaine) and Group 2 (0.5% bupivacaine). Patients received weekly GON blocks for four weeks, followed by monthly sessions for six months. Pain levels were measured using the Visual Analogue Scale (VAS) at the initial visit (VAS-1), after the first month (VAS-2), and at six months (VAS-3). Results: Both bupivacaine concentrations significantly reduced VAS scores over time. In Group 1, the mean VAS score decreased from 8.49 at baseline to 4.80 at the first month and 4.21 at six months. In Group 2, the VAS scores decreased from 8.65 to 4.35 at the first month and 3.2 at six months. The reductions within each group were statistically significant (p<0.01); however, no significant differences were found between the groups at any time point (VAS-1, p=0.588; VAS-2, p=0.329; VAS-3, p=0.144). The differences in pain reduction between the two groups (VAS-1 to VAS-2 and VAS-1 to VAS-3)were also not statistically significant (p=0.218 and p=0.271, respectively). Conclusion: The findings suggest that both 0.25% and 0.5% bupivacaine are effective in reducing pain in patients with migraine, with no added benefit from the higher concentration. Future studies with larger samples and different methodologies are recommended to further refine GON block protocols.

Keywords

• Migraine
• Headache
• Greater Occipital Nerve Block
• Preventive Treatment

Bupivakain Konsantrasyonu önemli midir? Büyük Oksipital Sinir Blokajlarında %0,25 ve %0,5 Bupivakainin karşılaştırmalı bir çalışması

Abstract

Amaç: Bu çalışmada, kronik migren hastalarında büyük oksipital sinir (BOS) bloklarında iki farklı bupivakain konsantrasyonunun (%0,25 ve %0,5) etkinliğini değerlendirme amaçlandı. Yöntemler: Bu retrospektif analizde, 2019-2021 yılları arasında tedavi edilen 72 kronik migren hastası iki gruba ayrıldı: Grup 1 (%0,25 bupivakain) ve Grup 2 (%0,5 bupivakain). Hastalara dört hafta boyunca haftada bir BOS blok tedavisi, ardından altı ay boyunca aylık seanslar uygulandı. Ağrı düzeyleri, ilk başvuru (VAS-1), birinci ay (VAS-2) ve altıncı ay (VAS-3) ölçümleriyle Görsel Analog Skala (VAS) kullanılarak değerlendirildi. Bulgular: Her iki bupivakain konsantrasyonu da zaman içinde VAS skorlarını anlamlı şekilde azalttı. Grup 1’de ortalama VAS skoru başlangıçta 8,49 iken, birinci ayda 4,80’e ve altıncı ayda 4,21’e düştü. Grup 2’de ise VAS skorları 8,65’ten birinci ayda 4,35’e ve altıncı ayda 3,2’ye geriledi. Her iki gruptaki azalmalar istatistiksel olarak anlamlıydı (p < 0,01); ancak hiçbir zaman noktasında gruplar arasında anlamlı fark bulunmadı (VAS-1, p=0,588; VAS-2, p=0,329; VAS-3, p=0,144). Ağrı azalmasındaki grup farkları da (VAS-1’den VAS-2’ye ve VAS-1’den VAS-3’e) istatistiksel olarak anlamlı değildi (sırasıyla p=0,218 ve p=0,271). Sonuç: Bulgular, hem %0,25 hem de %0,5 bupivakainin migren hastalarında ağrıyı azaltmada etkili olduğunu, ancak daha yüksek konsantrasyonun ek bir fayda sağlamadığını göstermektedir. Daha büyük örneklemler ve farklı metodolojilerle yapılacak gelecekteki çalışmalar, BOS blok protokollerinin daha da netleştirilmesine katkı sağlayabilir.

Keywords

• Migren
• Baş ağrısı
• Büyük Oksipital Sinir Bloğu
• Önleyici Tedaviler.

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