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Effect of Bilateral Greater Occipital Nerve Block on Headache After Intracranial Aneurysm Coiling
Sponsor: Konya City Hospital
Summary
Postoperative headache is a common complication following endovascular coil embolization of intracranial aneurysms and may increase analgesic requirements, impair patient comfort, and contribute to hemodynamic instability. The greater occipital nerve (GON) has anatomical and functional connections with the trigeminocervical complex, suggesting that greater occipital nerve blockade may modulate headache-related pain pathways. However, the effectiveness of prophylactic greater occipital nerve block in patients undergoing elective endovascular coiling of unruptured intracranial aneurysms remains uncertain. This prospective, randomized, sham-controlled, single-center clinical trial aims to investigate whether preoperative ultrasound-guided bilateral greater occipital nerve block reduces postoperative headache intensity during the first 24 hours following endovascular coil embolization. A total of 76 patients will be randomly allocated in a 1:1 ratio to receive either ultrasound-guided bilateral greater occipital nerve block with 0.25% bupivacaine or bilateral superficial sham injections with 0.9% normal saline. The active intervention will consist of 3 mL of 0.25% bupivacaine administered on each side in the fascial plane between the semispinalis capitis and obliquus capitis inferior muscles. The control intervention will consist of a superficial subcutaneous injection of 0.5 mL of 0.9% normal saline on each side. All participants will receive standardized general anesthesia and postoperative multimodal analgesia. The primary outcome will be the time-weighted average resting pain score during the first 24 postoperative hours, calculated from the area under the Numeric Rating Scale (NRS) pain score-time curve.
Official title: Effect of Preoperative Ultrasound-Guided Bilateral Greater Occipital Nerve Block on Postoperative Headache Following Endovascular Coiling of Unruptured Intracranial Aneurysms: A Prospective, Randomized, Sham-Controlled Trial
Key Details
Gender
All
Age Range
18 Years - 65 Years
Study Type
INTERVENTIONAL
Enrollment
76
Start Date
2026-11-02
Completion Date
2027-12-02
Last Updated
2026-11-02
Healthy Volunteers
No
Conditions
Interventions
Ultrasound-Guided Bilateral Greater Occipital Nerve Block
Ultrasound-guided bilateral greater occipital nerve block will be performed before general anesthesia induction using a high-frequency linear ultrasound transducer. The greater occipital nerve will be identified between the semispinalis capitis and obliquus capitis inferior muscles. A 25-gauge, 50-mm echogenic needle will be advanced under continuous ultrasound guidance using an in-plane approach. Following color Doppler assessment and negative aspiration, 3 mL of 0.25% bupivacaine (7.5 mg) will be injected slowly and incrementally on each side. The total bilateral dose will be 15 mg of bupivacaine.
Bilateral Superficial Subcutaneous Sham Injection
A bilateral superficial subcutaneous sham injection will be performed before general anesthesia induction. Following standardized positioning, skin antisepsis, and ultrasound examination, a short 27-gauge needle will be used to administer 0.5 mL of 0.9% normal saline subcutaneously on each side of the occipital region. The total bilateral injection volume will be 1 mL. The needle will not be advanced into the deep interfascial plane, and the greater occipital nerve will not be directly targeted.
Locations (1)
Konya City Hospital
Konya, Konya, Turkey (Türkiye)