3 —) Technique of injection: palpate for the temporal artery alo

3 —). Technique of injection: palpate for the temporal artery along its course anterior to the tragus and inject 2 mm anterior to it at a depth of 4-6 mm (Fig. 3 —). Carefully verify that the needle is not intravascular by gentle negative aspiration before injecting. Additional injections may be performed more superiorly, at the temporal fossa, where the nerve gives off multiple branches. Alternatively, insert the needle at the posterior margin of the mandibular ramus, at a level just inferior to the tragus. Inject at a depth of 20 mm at this point. CHIR-99021 solubility dmso Volume of injection: 0.5-1.0 mL for the single injection at the

proximal part of the nerve (more if injecting the superior branches as well, 0.25 mL for each additional injection). Drugs used are

the same as for the STN and SON blocks. Specific outcomes that are commonly reported relate to both the technical success of the PNB, as well as the clinical outcome, including reduction in head pain, attack frequency, disability, use of rescue medications, and analgesic overuse. A technically successful block will result in anesthesia in the blocked nerve territory (Fig. 4 —). This achievement is a function of appropriate identification of anatomical landmarks and infiltration of an adequate amount of the selected local anesthetic. Clinical outcomes can be defined based on the clinical circumstance and indication: when treating a patient with an acute migraine attack for rescue purposes, achieving pain freedom would be an appropriate treatment goal, while in treating a CH patient, terminating the headache cycle would be a more reasonable objective. PNBs are also used for transitional

http://www.selleckchem.com/products/PLX-4032.html therapy in patients with medication overuse, during the weaning period, and as a preventive treatment in patients with chronic daily headache (CDH). Outcome parameters tetracosactide include not only pain relief, but also the ability to return to normal level of activity. The probability of a desirable clinical and functional outcome can be improved with technically successful blocks, as well as with education of the patient regarding appropriate expectations. Reinjection can be performed as clinically indicated. Typically, this would occur for patients with migraine in at least 2-4 week intervals, as the benefits usually last days to weeks, although the duration of therapeutic effect varies among patients. However, recent evidence suggests that PNBs to suppress a CH attack period may be beneficial and safe with a series of 3 injections, each 48 to 72 hours apart.[7] The indication for treatment will also affect the decision on when to reinject: for the purpose of rescue care of an individual attack, re-treatment is unlikely to be necessary if the patient experiences prompt pain relief. Conversely, for transitional care in an individual who is weaning from pain medication overuse, there may be a need for re-treatment in 2-4 weeks.

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