Early occipital nerve blockade with lidocaine and dexamethasone is a safe and effective choice for managing patients with drug-resistant ON-APCH. It minimizes pain and may prevent the development of refractory occipital neuralgia, says a retrospective study published in "Pain Research and Management". Shaoheng Wang et al. undertook this study to explore the therapeutic efficacy and safety of occipital nerve blockade on ON-APCH.

The data were retrospectively collected from electronic institutional medical documents and case records (from January 2012 and December 2020). In total, 41 subjects having drug-resistant ON-APCH after elective craniotomy and were given occipital nerve blockade with lidocaine for diagnoses were enrolled in the trial. All the subjects were treated with lidocaine and dexamethasone.

The intensity of pain and occipital nerve blockade-linked complications and adverse effects were examined at different time points: (i) prior to occipital nerve blockade, (ii) at one day after occipital nerve blockade, and (iii) at discharge. It was noted that the mean NRS before occipital nerve blockade  declined considerably after occipital nerve blockade  and at discharge, as shown in the table below:

After one month, complete pain alleviation without medicines was noted in 73% of patients (n=30) whereas, after three months, only 5% (n=2) patients had to continue oral medications for maintaining pain relief. As such, there were no side effects or complications noted instantly after or within three months of nerve blockade.

Thus, the authors conclude that the occipital nerve blockade approach can safely and effectively alleviate pain, and also prevent the development of refractory occipital neuralgia.