This prospective randomized controlled study aims to compare the analgesic effectiveness of ultrasound-guided cervical medial branch block and ipsilateral cervical erector spinae plane block in patients with cervical facetogenic pain.

Patients with chronic cervical facet-mediated pain will be randomized into two intervention groups. Pain intensity, functional status, meaningful pain response rates, analgesic consumption, and patient satisfaction will be evaluated during follow-up.

The primary objective is to determine whether cervical erector spinae plane block provides comparable short-term pain relief to cervical medial branch block.

Cervical facet joints are an important source of chronic axial neck pain. Diagnostic cervical medial branch block is commonly used to identify facet-mediated pain and may also provide short-term analgesic benefit. However, this procedure requires precise targeting of the cervical medial branches and may be technically demanding in some patients.

The cervical erector spinae plane block is an ultrasound-guided interfascial plane block that may provide analgesia through cranio-caudal spread of local anesthetic along the paraspinal fascial plane. Although it has been increasingly used for perioperative and chronic pain indications, its role in cervical facetogenic pain has not been clearly established.

This study will compare the short-term analgesic effectiveness of ultrasound-guided cervical medial branch block and ipsilateral cervical erector spinae plane block in patients with clinically suspected cervical facetogenic pain. Eligible patients will be randomized to receive one of the two ultrasound-guided interventions. Pain intensity, functional disability, meaningful pain response, analgesic use, patient satisfaction, and procedure-related adverse events will be assessed during follow-up.

The study is designed to determine whether cervical erector spinae plane block can provide clinically meaningful pain relief comparable to cervical medial branch block in this patient population.

Inclusion Criteria:

• Age between 18 and 80 years
• Chronic neck pain lasting at least 3 months
• Clinical findings suggestive of cervical facetogenic pain
• Numeric Rating Scale pain score ≥4
• Ability to provide informed consent

Exclusion Criteria:

• Cervical radiculopathy or myelopathy
• Major neurological deficit
• Infection at the injection site
• Coagulopathy or anticoagulant therapy contraindicating intervention
• Allergy to local anesthetics
• Pregnancy
• Previous cervical interventional pain procedure within the last 3 months
• Severe psychiatric disease

Participants will be blinded to treatment allocation. Due to the technical and procedural differences between the interventions, the physician performing the procedure cannot be blinded.