Chapter: Clinical Anesthesiology: Regional Anesthesia & Pain Management: Chronic Pain Management
Occipital Nerve Block
Occipital Nerve Block
A. Indications
Occipital nerve block is useful diagnostically and therapeutically in
patients with occipital headaches and neuralgias.
B. Anatomy
The greater occipital nerve is derived from the dor-sal primary rami of
the C2 and C3 spinal nerves, whereas the lesser occipital nerve arises from the
ventral rami of the same roots.
C. Technique
The greater occipital nerve is blocked
approximately 3 cm lateral to the occipital prominence at the level of the
superior nuchal line ( Figure 47–10);
the nerve is just medial to the occipital artery, which is often pal-pable. The
lesser occipital nerve is blocked 2–3 cm more laterally along the nuchal ridge.
Ultrasoundguidance may be employed to help identify the nerves and minimize the
risk of inadvertent intra-venous or intraarterial injection. For patients who
have responded well but temporarily to occipital
nerve blocks, implantation of an occipital nerve stimulator may provide
prolonged relief.
D. Complications
Rarely, intravascular injections may occur.
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