Nerve Block: Occipital
Revision as of 23:42, 13 July 2015 by Mholtz (talk | contribs) (Mholtz moved page Occipital Nerve Block to Nerve Block: Occipital: standard syntax for nerve block pages)
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.