• Medicine · Dec 2021

    Meta Analysis

    Efficacy of greater occipital nerve block for pain relief in patients with postdural puncture headache: A meta-analysis.

    • Ying-Jen Chang, Kuo-Chuan Hung, I-Wen Chen, Chi-Lin Kuo, I-Chia Teng, Ming-Chung Lin, Ming Yew, Shu-Wei Liao, Chung-Yi Wu, Chia-Hung Yu, Kuo-Mao Lan, and Cheuk-Kwan Sun.
    • Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
    • Medicine (Baltimore). 2021 Dec 23; 100 (51): e28438e28438.

    BackgroundThis study aimed at assessing the therapeutic effectiveness of greater occipital nerve block (GONB) against postdural puncture headache (PDPH).MethodsStudies investigating analgesic effects of GONB against PDPH in adults were retrieved from the MEDLINE, EMBASE, Google scholar, and Cochrane central databases from their inception dates to May, 2021. Pain score at postprocedural 24 hours was the primary endpoint, while secondary endpoints were pain score at postprocedural 1 hour and 12 hours as well as the risk of intervention failure.ResultsOf the 7 studies (randomized controlled trials [RCTs], n = 4; non-RCTs, n = 3) that recruited 275 patients, 2 investigated female patients undergoing cesarean section and the other 5 were conducted in both obstetric and nonobstetric settings. Pooled results showed a lower mean pain score at 24 hours (i.e., primary outcome) (mean difference [MD] = -2.66, 95%: CI: -3.98 to -1.33, P < .001; I2 = 97%, 6 studies), 1 hour (MD = -4.23, 95% confidence interval [CI]: -5.08 to -3.37, P < .00001; I2 = 86%, 5 studies), and 6 hours (MD = -2.78, 95% CI: -4.99 to -0.57, P = .01; I2 = 98%, 4 studies) in patients with GONB compared to those without. Trial sequential analysis supported the robustness of evidence at postprocedural 24 hours. The use of GONB also decreased the risk of intervention failure (relative ratio [RR] = 0.4, 95% CI: 0.19 to 0.82, P = .01; I2 = 96%, 6 studies, 277 patients).ConclusionOur results suggested a therapeutic effect of greater occipital nerve block against postdural puncture headache up to postprocedural 24 hours. Further large-scale studies are warranted to evaluate its therapeutic benefit beyond the acute stage.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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