射频治疗枕神经痛112例报告

临床资料：112例病人中，枕大神经痛101例，男48例，女53例。枕小神经痛11例，男2例，女9例。年龄17～65岁。病程29天～8年。治疗方法：射频机的负极针刺入一侧领肌，正极针根据不同神经痛的部位选择：枕大神经取乳突与枕后粗隆之间连线的中点；枕小神经取该连线的外1／3交点。当针刺准部位时，该神经分布区呈“犯病”样疼痛，用方波试测时也有同样发作，即可行射频温控热凝治疗。将温度调升到80～85℃，此时患者有一过性疼痛，而后疼痛逐渐消失。每次治疗持续1～2分钟，休息2～3分钟，重复射频治疗2～3次，当疼痛完全消失，该神经区麻术，…     

神经阻滞加针刀治疗椎枕肌劳损

颈椎病是中老年人的常见病、多发病，是颈部众多疾病的统称。椎枕肌劳损所引起的颈椎病是为其中之一，虽少有人提及，但临床并不鲜见，且有人将其误诊为寰枕筋膜挛缩型颈椎病。为了配合针刀治疗椎枕肌劳损，我们进行了应用解剖学研究，给针刀医学提供形态学资料神经阻滞治疗该病效果显著，但疗程长、注药次数多，为此，我们在神经阻滞的基础上加针刀治疗椎枕肌劳损38例，并进行了疗效随访，现报告如下。     

埋针治疗枕神经痛30例

枕神经痛是枕骨下和后脑部的疼痛，常为持续性的，亦可阵发性加剧，可由多种原因引起，笔者运用埋针治疗一些枕神经痛（除外后颅窝病变）取得良好疗效，现报道如下。１对象与方法本组３０例，男１８例，女１２例；年龄２２～５６岁，病程３d～６个月；一侧痛２６例，双侧痛４例。方法：风池、翳明、阿是穴为主穴，配玉枕、翳风、率谷、天柱、脑空、玉机。常规穴位消毒，绷紧埋针处皮肤，用镊子夹住消毒的揿针，快速刺入所选用的穴位，风池可选用０．５寸毫针埋针以加强刺激力度，用胶布固定。每次选３～４个穴位，留针两三天，单侧痛埋单侧…     

当归注射液治疗枕神经痛50例观察

枕神经痛在头痛疾患中常见。呈后头部与上颈部发作性剧痛,常放射至同侧颞顶部,可伴有恶心,呕吐,头晕等。病因有多方面的,作为对症治疗,各种镇静退热止痛剂对本病疗效不理想,无水酒精局     

星状神经节阻滞联合枕大神经阻滞治疗失眠48例

以往对失眠患者的处理常规应用镇静、催眠类药物进行对症治疗。患者容易产生耐药性、依赖性,从而不得不逐渐增加剂量,突然撤药还可引发反跳性失眠[1]。2005年1月至2010年12月笔者采用星状神经节阻滞（SGB）联合枕大神经阻滞治疗失眠患者48例,效果满意,报告如下。     

周围神经电刺激治疗顽固性枕神经痛一例

2005年我院对一例慢性顽固性枕神经痛的患者实施了周围神经电刺激术，取得了很好的疗效，现报道如下。资料与方法1．一般资料患者男，63岁。诉右颈枕部疼痛30余年，有时放射到右头顶部，加重3年。疼痛呈针刺样或电击样，阵发性发着，持续时间由十分钟延长至约0．5～2小时／次，疼痛发作时VAS达8～9分。夜间发作明显，严重影响睡眠。曾在多家医院就诊，长期服用得理多及曲马多等药物、也行过针刀和射频等治疗，[第一段]     

封闭治疗枕大神经痛112例

我们自1979～1985年,对112例枕大神经痛患者采用醋酸可的松加普鲁卡因封闭治疗,疗效较满意,现报告如下: 一般资料112例中男64例,女48例。年龄:16～25岁23例,26～35岁48例,36～45岁29例,46岁以上者12例。78例为首次发病,34例发病2次以上。病程:     

神经阻滞治疗带状疱疹痛的体会

近二年来我们采用神经阻滞法治疗带状疱疹 20例,获得满意的临床疗效,现总结如下。 1资料与方法20例患者均处于带状疱疹急性期,伴有剧烈疼痛,年龄 19～ 77岁,平均 56岁,男 8例,女 12例,ASA I～ III级。发病部位：头颈、面部 8例;脑背部 7例;腰部 5例。方法：对头、颈、面部患者可采用星状神经结阻滞法,用 0.5％布比卡因或 2％利多卡因 5ml＋地塞米松 5mg＋维生素 B1 100mg＋维生素 B12 0.5mg,共 10ml,每次注射10ml,1次 /d,注射于 C6横突部位,对胸背部及腰部患者,可根据病变部位相应的脊神经进行椎旁神经根阻滞,药液配…     

Nerve block plus manual management in the treatment of occipital neuralgia

Objective:To investigate management approaches and therapeutic effect of occipial neuralgia.Method:112 patients were randomly divided into 2 grops.study group and control group,each having 10 patients,Study group received nerve bolck plus manual management,Control group received manual management alone.Result 3-6 months follos up was perfomed,Results showed cure rate of study group was higher compared with conrol group（P＜0．05），Numbers of nerve block in study group was less than control group(P&;lt;0.01).Conclusion:Nerve block plus manual management is effective in treating occipital neuralgia.     

神经阻滞技术与周围神经痛

介绍三叉神经痛、舌咽神经痛、枕神经痛、颈椎性神经根痛、肋间神经痛、坐骨神经痛、股神经痛、股外侧皮神经痛、髂腹股沟及髂腹下神经痛等10种周围神经痛的病因和发病机制、临床症状、诊断以及治疗方法。神经阻滞(nerveblock,NB)技术治疗这些疾病是来源于麻醉学的一种独特的方法。当药物疗法或其他方法不见效时改用这种技术可获显著效果,于是详述眶上NB,眶下NB,上颌NB,下颌NB,颏NB,半月神经节乙醇、甘油、热凝NB,舌咽NB,枕NB,肋间NB,腰大肌肌沟阻滞,股NB,股外侧皮NB,髂腹股沟及髂腹下NB等18种NB技术的实施方法。     

Adverse effect profile of Lidocaine injections for occipital nerve block in occipital neuralgia

To determine whether there are differences in the adverse effect profile between 1, 2 and 5% Lidocaine when used for occipital nerve blocks (ONB) in patients with occipital neuralgia. Occipital neuralgia is an uncommon cause of headaches. Little is known regarding the safety of Lidocaine injections for treatment in larger series of patients. Retrospective chart analysis of all ONB was performed at our headache clinic during a 6-year period on occipital neuralgia patients. 89 consecutive patients with occipital neuralgia underwent a total of 315 ONB. All the patients fulfilled the IHS criteria for Occipital Neuralgia. Demographic data were collected including age, gender, and ethnicity. The average age of this cohort was 53.25 years, and the majority of patients were females 69 (78%). Ethnicity of patients was diverse, with Caucasian 48(54%), Hispanics 31(35%), and others 10 (11%). 69 patients had 1%, 18 patients had 2% and 29 patient were given 5% Lidocaine. All Lidocaine injections were given with 20 mg Depo-medrol and the same injection technique and location were used for all the procedures. Eight patients (9%)had adverse effects to the Lidocaine and Depo-medrol injections, of which 5 received 5% and 3 received 1% Lidocaine. Majority of patients who had adverse effects were female 7(87%), and had received bilateral blocks (75%). ONB is a safe procedure with 1% Lidocaine; however, caution should be exerted with 5% in elderly patients, 70 or older, especially when administering bilateral injections.     

Craniocervical junction schwannoma mimicking occipital neuralgia

Occipital neuralgia is a very well recognized cause of posterior headache. Although hypoesthesia may be found in the individual occipital nerve's territory, the remaining neurologic exam is typically normal. An abnormal neurologic exam is an alert for potential underlying causes of symptoms.     

普瑞巴林治疗枕神经痛的临床疗效观察

目的观察普瑞巴林治疗枕神经痛的疗效及安全性。方法将80例枕神经痛患者,随机分为治疗组（n=40）和对照组（n=40）。对照组常规予以非甾体类消炎镇痛药、活血化瘀及B族维生素等治疗,治疗组在此基础上加用普瑞巴林75~150 mg,2次/d。2组均观察3周,分别于治疗前及治疗后的1、2、3周进行自评、医评分值评价和临床疗效评价,判断普瑞巴林的疗效及安全性。结果 2组治疗前自评和医评分值比较。差异无统计学意义（P〉0.05）;2组治疗后1、2、3周,治疗组与对照组自评和医评分值比较,差异有统计学意义（P〈0.05）;临床疗效：治疗组有效率92.5%;对照组有效率52.5%,2组比较差异有统计学意义（P〈0.05）。两组均未发现严重副作用。结论普瑞巴林能有效改善枕神经痛患者的临床症状,副作用小,值得临床推广应用。     

The first 5 minutes after greater occipital nerve block

We performed greater occipital nerve blocks on 24 migraineurs with unilateral migraine and trigeminal nerve distribution allodynia. Using a visual analog scale for migraine pain, brush allodynia in the trigeminal nerve distribution and photophobia were reduced 64%, 75%, and 67%, respectively, after 5 minutes. Allodynia improved faster than headache. The results of this study suggest that greater occipital nerve blocks initiate an inhibitory process that shuts down several symptom generators.     

Response to occipital nerve block is not useful in predicting efficacy of occipital nerve stimulation

Occipital nerve stimulation (ONS) may be effective for the treatment of headaches that are recalcitrant to medical therapy. The objective of this study was to determine if response to occipital nerve block (ONB) predicts response to ONS in patients with chronic, medically intractable headaches. We evaluated 15 patients who underwent placement of occipital nerve stimulators for the treatment of chronic headaches. Data were collected regarding analgesic response to ONB and to ONS. Nine of 15 patients were ONS responders (> or =50% reduction in headache frequency or severity). Thirteen patients had ONB prior to stimulator implantation. Ten of 13 who had ONB had significant relief of head pain lasting at least 24 h, and three were ONB non-responders. Of the three ONB non-responders, two were ONS responders. Of the two patients who did not have ONB prior to ONS, one was an ONS responder and one was an ONS non-responder. In conclusion, analgesic response to ONB may not be predictive of the therapeutic effect from ONS in patients with medically refractory chronic headaches.