Nerve Block: Occipital: Difference between revisions
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*Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref> | *Nerve is between ~8-18 mm deep<ref>M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.</ref> | ||
=== | ==Indications== | ||
* | *Suspected or confirmed occipital neuralgia | ||
==Contraindications== | |||
*Overlying infection | |||
==Equipment Needed== | |||
*PPE | |||
*Local anesthetic | |||
*Syringe and 27-30ga needle | |||
{{Maximum doses of anesthetic agents}} | |||
==Procedure== | |||
*Traditionally done "blindly" with palpation of occipital protuberance | *Traditionally done "blindly" with palpation of occipital protuberance | ||
**Then palpate laterally to find the tender nerve on the side of the headaches | **Then palpate laterally to find the tender nerve on the side of the headaches | ||
**Palpate the occiptal artery above the superior nuchal line, and inject just medially to that | **Palpate the occiptal artery above the superior nuchal line, and inject 2-3cc of anesthetic just medially to that | ||
==Complications== | |||
*Damage to surrounding structures | |||
==Follow-up== | |||
==See Also== | |||
*[[Lidocaine]] | |||
==References== | |||
<references/> | |||
[[Category:Procedures]] | |||
Revision as of 23:38, 13 July 2015
Background
- Therapeutic and diagnostic for occipital neuralgia
- Nerve is between ~8-18 mm deep[1]
Indications
- Suspected or confirmed occipital neuralgia
Contraindications
- Overlying infection
Equipment Needed
- PPE
- Local anesthetic
- Syringe and 27-30ga needle
Maximum Doses of Anesthetic Agents
| Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
| Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
| Mepivicaine | 7 mg/kg | 8 mg/kg | ||
| Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
| Ropivacaine | 3 mg/kg | |||
| Prilocaine | 6 mg/kg | |||
| Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
| Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Procedure
- Traditionally done "blindly" with palpation of occipital protuberance
- Then palpate laterally to find the tender nerve on the side of the headaches
- Palpate the occiptal artery above the superior nuchal line, and inject 2-3cc of anesthetic just medially to that
Complications
- Damage to surrounding structures
Follow-up
See Also
References
- ↑ M. Greher, B. Moriggl, M. Curatolo, L. Kirchmair and U. Eichenberger. Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection. Br. J. Anaesth. (2010) 104 (5): 637-642.