Effect of Bilateral Greater Occipital Nerve Block on Headache After Intracranial Aneurysm Coiling
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- Are you between 18 and 65 years old?
Source: NCT07910864, who can take part
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Print a page for my doctorTrial details
- Who runs it
- Konya City Hospital
- Trial code
- NCT07910864
- Record updated
- 2 November 2026
- Original description
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.Read full original descriptionShow less
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
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.
Inclusion: Patients aged 18-65 years; American Society of Anesthesiologists (ASA) physical status I-III; Patients scheduled for elective endovascular coil embolization of a unilateral unruptured intracranial aneurysm under general anesthesia; Ability and willingness to provide written informed consent.
Exclusion: Ruptured intracranial aneurysm or acute subarachnoid hemorrhage requiring emergency intervention; Clinical contraindications to greater occipital nerve block, including infection or skin lesions at the injection site, local anesthetic allergy, or anatomical conditions preventing safe needle placement; Known history of severe hypersensitivity or allergic reactions to local anesthetics; Chronic opioid use, chronic pain syndrome, or regular analgesic use that may substantially interfere with postoperative pain assessment; Uncontrolled hypertension or clinically significant uncontrolled cardiac arrhythmia; Neurological deficits, aphasia, impaired consciousness, cognitive impairment, or communication difficulties preventing reliable pain assessment using the Numeric Rating Scale; Platelet count below 100,000/mm³, international normalized ratio (INR) greater than 1.5, activated partial thromboplastin time (aPTT) greater than 1.5 times normal, or clinically significant coagulopathy; Refusal to provide informed consent or subsequent withdrawal of consent; Antithrombotic or antiplatelet treatment that does not meet the predefined safety intervals for deep peripheral nerve blocks according to the ASRA 2025 and ESAIC/ESRA guidelines; Moderate-to-severe preoperative headache, defined as a resting Numeric Rating Scale score of 3 or higher; Pregnancy or breastfeeding; Body mass index greater than 35 kg/m²; Clinical circumstances requiring initiation of intravenous unfractionated heparin within one hour after the planned study-related needle intervention.