Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block

Abbas, Abdelrahman; Moustafa, Ramez Reda; Shalash, Ali; Haroun, Mahmoud; Amin, Randa M.; Borham, Sherien Mohamed Farag; ElSadek, Ahmed; Helmy, Shahinaz

doi:10.3390/neurolint14010016

Cited by 6 publications

(6 citation statements)

References 19 publications

(24 reference statements)

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“…§Odd's ratio 95%CI: 95% confidence interval. for migraine, after ultrasound-guided bilateral GONB compared to pre-blockade level (28). Similarly, improvement in neurophysiological correlates of CM following GONB has been reported (29).…”

Section: Discussionmentioning

confidence: 69%

“…In fact, a previous study showed that the effect of single GONB lasts far longer than its anesthetic effect (13). Though the exact mechanisms of such modulations remain unknown, a clinical study has shown a significant drop in interictal serum CGRP levels, a biomarker for migraine, after ultrasound-guided bilateral GONB compared to pre-blockade level (28). Similarly, improvement in neurophysiological correlates of CM following GONB has been reported (29).…”

Section: Discussionmentioning

confidence: 99%

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Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study

et al. 2023

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Background Greater occipital nerve blockade for the prevention of chronic migraine has a limited evidence base. A robust randomized double-blind, placebo-controlled trial is needed. Methods This double-blind, placebo-controlled, parallel-group trial, following a baseline period of four weeks, randomly assigned patients of chronic migraine 1:1 to receive four-weekly bilateral greater occipital nerve blockade with either 2 ml of 2% (40 mg) lidocaine (active group) or 2 ml of 0.9% saline (placebo) injections for 12 weeks. The primary and key secondary efficacy endpoints were a change from the baseline in the mean number of headache and migraine days and the achievement of ≥50% reduction in headache days from baseline across the weeks 9–12 respectively. Safety evaluations included the documentation and reporting of serious and other adverse events. Results Twenty-two patients each were randomly allocated to the active and placebo group. Baseline demography and clinical characteristics were similar between the two groups. Mean headache and migraine days at baseline (±SD) were 23.4 ± 4.4 and 15.6 ± 5.7 days in the active group and 22.6 ± 5.0 and 14.6 ± 4.6 days in the placebo group respectively. The active group compared to the placebo had a significantly greater least-squares mean reduction in the number of headache and migraine days (−4.2 days [95% CI: −7.5 to −0.8; p = 0.018] and −4.7 days [95%CI: −7.7 to −1.7; p = 0.003] respectively). 40.9% of patients in the active group achieved ≥50% reduction in headache days as compared with 9.1% of patients receiving a placebo (p = 0.024). Overall, 64 mild and transient adverse events were reported by 16 patients in the active group and 15 in the placebo. No death or serious adverse events were reported. Conclusion Four-weekly greater occipital nerve blockade with 2% lidocaine for 12 weeks was superior to placebo in decreasing the average number of headache and migraine days in patients with chronic migraine with a good tolerability profile. Clinical trial.gov no. CTRI 2020/07/026709

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study

et al. 2023

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“…Our literature analysis (Table 1 ) shows that studies based on CGRP determinations are highly variable in terms of measuring method and study design, including sample source, sample processing, inclusion/exclusion criteria for patients and controls and aim of the study [ 14 , 15 , 19 , 31 , 39 , 42 , 60 , 66 , 68 ]. Data analysis and presentation of laboratory determinations is also changeful, which hinder the comparison of the data.…”

Section: Discussionmentioning

confidence: 99%

Untangling the mess of CGRP levels as a migraine biomarker: an in-depth literature review and analysis of our experimental experience

Gárate,

Pascual,

Pascual-Mato

et al. 2024

J Headache Pain

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Background Calcitonin gene-related peptide (CGRP) is the most promising candidate to become the first migraine biomarker. However, literature shows clashing results and suggests a methodological source for such discrepancies. We aimed to investigate some of these methodological factors to evaluate the actual role of CGRP as biomarker. Methods Previous to the experimental part, we performed a literature review of articles measuring CGRP in migraine patients. Using our 399 bio-bank sera samples, we performed a series of experiments to test the validity of different ELISA kits employed, time of sample processing, long-term storage, sampling in rest or after moderate exercise. Analysis of in-house data was performed to analyse average levels of the peptide and the effect of sex and age. Results Literature review shows the high variability in terms of study design, determination methods, results and conclusions obtained by studies including CGRP determinations in migraine patients. CGRP measurements depends on the method and specific kit employed, also on the isoform detected, showing completely different ranges of concentrations. Alpha-CGRP and beta-CGRP had median with IQR levels of 37.5 (28.2–54.4) and 4.6 (2.4–6.4)pg/mL, respectively. CGRP content is preserved in serum within the 24 first hours when samples are stored at 4°C after clotting and immediate centrifugation. Storages at -80°C of more than 6 months result in a decrease in CGRP levels. Moderate exercise prior to blood extraction does not modulate the concentration of the peptide. Age positively correlates with beta-CGRP content and men have higher alpha-CGRP levels than women. Conclusions We present valuable information for CGRP measurements in serum. ELISA kit suitability should be tested prior to the experiments. Alpha and beta-CGRP levels should be analysed separately as they can show different behaviours even within the same condition. Samples can be processed in a 24-h window if they have been kept in 4°C and should not be stored for more than 6 months at -80°C before assayed. Patients do not need to rest before the blood extraction unless they have performed a high-endurance exercise. For comparative studies, sex and age should be accounted for as these parameters can impact CGRP concentrations. Graphical Abstract

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“…Such diaries, while obviously not on par with clinical assessments, are well documented and used routinely in clinical studies for longer-term evaluations. 46 Table 2 provides the details regarding primary and secondary outcomes, and it should be considered that the median values in this table are confined to sessions that resulted in successful blockade, thus greatly underestimating the true difference between both drugs.…”

Section: Discussionmentioning

confidence: 99%

Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers

Zadrazil,

Marhofer,

Opfermann

et al. 2024

Anesthesiology

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Background Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that we would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, we designed a randomized, controlled, triple-blinded, single-center study in volunteers. Methods Volunteers aged 18 to 55 years (body mass index: 18 to 35 kg/m²) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of ≥ 36 days, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar's tests, as well as a generalized estimation equation model. Results Successful sensory blockade was noted in 8/25 volunteers (32%) after liposomal and in 25/25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in 4/5 hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in 1/5 areas (P < 0.001; 0.001). Carry-over effects due to the randomized sequencing were unlikely (estimate: −0.6286; SE: 0.8772; P = 0.474). Self-assessment over 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade. Conclusions Our results show that liposomal bupivacaine is not a suitable 'sole' drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy.

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Serum CGRP Changes following Ultrasound-Guided Bilateral Greater-Occipital-Nerve Block

Cited by 6 publications

References 19 publications

Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study

Greater occipital nerve blockade for the preventive treatment of chronic migraine: A randomized double-blind placebo-controlled study

Untangling the mess of CGRP levels as a migraine biomarker: an in-depth literature review and analysis of our experimental experience

Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers

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