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Peripheral nerve blocks: A tool for inpatient pediatric Status Migrainosus

      Abstract

      Objective

      To assess the efficacy and safety of peripheral nerve blocks in the inpatient settings for pediatric patients presenting with status migrainosus.

      Methods

      An analysis of a retrospective cohort of patients age range 13-18 years, admitted for status migrainosus from 2017 to 2022, was performed. Amongst the 1805 patients who presented with status migrainosus, 265 required hospital admission. A total of 177 patients failed the first- and second-line intravenous therapy and were treated with either peripheral nerve block (PNB) or dihydroergotamine (DHE) intravenous infusions. The primary outcome of the study was pain score level reduction by 50% and the secondary outcome was duration of hospital stay. A Visual Analogue Scale (VAS) score was used for pain assessment.

      Results

      Amongst the 177 patients, 100 patients were treated with DHE and 77 were treated with PNB. Target pain control was achieved in 59/100 in DHE patients and 38/77 amongst the PNB patients. The average hospital stay of patients who responded to PNB was significantly lower compared to patients receiving DHE (3.6 days vs 4.9 days). Among the 41 patients that were refractory to DHE, 30 patients received PNB, out of which 12 responded to nerve blocks. Most common side effect for PNBs were pain at injection site in 39% of patients and nausea/vomiting for DHE in 50% of patients.

      Conclusion

      PNB can be safely administered in the hospital setting to pediatric patients with status migrainosus. PNB treatment helped achieve target pain control with minimal side effects and reduced the hospital stay duration.

      Key words

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