Occipital Nerve Block

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For a landmark based approach of an occipital nerve block, start by palpating the mastoid process and occipital protuberance and imagine a line between them. The greater occipital nerve (GON) is 1/3 of the distance on the medial side. The lesser occipital nerve (LON) is 1/3 of the distance on the lateral side. Palpate the occipital artery to avoid it, and always aspirate before you inject. A 50:50 mixture of a local anesthetic (e.g. 2% lidocaine) with a corticosteroid (e.g. methylprednisolone or triamcinolone) can be used. Volume ranges in the literature, but 3 ml at each site should be adequate.

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Emil I. -

As always a great and instructional video! I really appreciate and respect all of your hard work. With regards specifically to these instructional videos, has it been considered briefly touching upon indications, contraindications and pitfalls to ensure the procedures are not performed inappropriately?

Carlos J. -

Great Job Stephanie!
-Carlos PA-C

Nate B., M.D. -

The injection on the video appeared fairly shallow- is there an ideal depth at which you should inject, or will the anesthetic diffuse down to the nerve if you inject fairly superficially?

Joseph B. -

Nate, I love these and perform them very often.

However, I use GONBs only on patient's with occipital pain to palpation, no neuro deficits and on patient's who have an intact, unadulterated occipital bone (ask about trauma or surgery first). I use only Bupivacaine (no steroid-although I might try it) and after finding my landmarks, I insert the needle at an angle away from the c-spine until I reach the occipital bone, back the needle off about 1-2mm, aspirate and then inject. Works about 60% of the time. Usually, results are within a couple minutes and are dramatic. This procedure takes a 1-2 hours HA cocktail and turns it into a 10-15 minute quick discharge!

Michael d. -

This seems like something that could really speed things up for patients, especially with all the waiting room medicine being practiced these days (cough... boarding/covid...)

I do have a couple questions. Are there data on complications from these injections? Also, it would make sense to me to inject ipsilateral to the headache (similar to the sphenopalantine block), is that what is suggested?

Thanks! Mike

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