Rafi DOĞAN, Hüseyin Ulaş PINAR, Ömer KARACA, Fatma KARAKOÇ

Ultrasound-guided bilateral greater occipital nerve block on headache seen after endovascular treatment of ruptured or unruptured intracranial aneurysms: A case report

Headache is a common symptom in subarachnoid hemorrhage (SAH). Often, pain control is difficult and opioid use can have a complicated effect on the patient’s state of consciousness. In this study of 2 cases, opioid consumption was reduced while effective pain control of headache occurring after endovascular treatment of an intracranial aneurysm was achieved using an ultrasound-guided, bilateral greater occipital nerve (GON) block. Case 1 was a 59-year-old male patient with a Glasgow Coma Scale (GCS) of 13 who was diagnosed with Fisher scale grade 3 SAH. Coiling and stenting were performed for an anterior communicating artery aneurysm. Cerebrospinal fluid drainage was provided with a lumbar spinal catheter. Case 2 was a 55-yearold male patient with a GCS of 15 who underwent coiling of a fusiform aneurysm in the left basilar artery and stenting of the stenotic region due to a basilar artery aneurysm. After the procedure, the visual analog score (VAS) of the patients was 9 and 7, respectively, and a bilateral GON block was performed with ultrasound guidance. The VAS score of both patients decreased to 3 and did not exceed 3 during follow-up in the intensive care unit, eliminating the need for additional analgesics. A bilateral GON block provided effective analgesia and significantly reduced the need for other pain relief in both cases.

Rüptüre olmuş ve olmamış intrakraniyal anevrizmaların endovasküler tedavisi sonrası görülen başağrısında ultrason eşliğinde bilateral büyük oksipital sinir bloğu: Bir olgu sunumu

SAK olgularında başağrısı sık görülen semptomdur. Çoğu zaman ağrı kontrolü güç olmakta ve opioid kullanılarak hastanın şuur durumu daha karmaşık hale gelmektedir. Çalışmada, ultrason eşliğinde bilateral büyük oksipital sinir bloğu ile intrakraniyal anevrizmaların endovasküler tedavisi (EVT) sonrası görülen başağrısının etkili kontrolünü ve opioid tüketimini azaltmayı amaçladık. Olgu1 – Fisher 3 grade SAK tanısıyla gelen, GKS: 13 olan 59 yaşında erkek hastaya, anteriör kominikan arterde anevrizma nedeniyle koilizasyon ve stent uygulaması yapıldı. Lomber spinal kateterle BOS drenajı sağlandı. Olgu 2 – Baziller arter anevrizması nedeniyle, sol baziller arterde fusiform anevrizmaya koilizasyon ve stenotik bölgeye stent uygulanan GKS: 15 olan 55 yaş erkek hasta değerlendirildi. VAS skorları sırasıyla 9–7 olan hastalara, ultrasound eşliğinde bilateral büyük oksipital sinir bloğu sağlandı. Her iki hastanın VAS skoru 3 ün altına düştü. Skor takip boyunca 3’ü aşmadı ve ek analjezik ihtiyacı olmadı. Sonuç olarak, iki olguda da bilateral oksipital sinir bloğu ile etkili analjezi sağlanmıştır ve ek analjezik ihtiyacı çok azalmıştır

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