Nerve Block: Occipital

Background

• Therapeutic and diagnostic for occipital neuralgia
• Nerve is between ~8-18 mm deep

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	1% soln contains 10 mg/ml 2% soln contains 20 mg/ml
Mepivicaine	7 mg/kg	8 mg/kg
Bupivicaine	2.5 mg/kg (max 175mg)	3 mg/kg (max 225mg)	6-8 hr	0.5% soln contains 5 mg/ml May cause cardiac arrest if injected intravascularly Do not buffer with bicarbonate
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

See Also

• Nerve Blocks (Main)
• Lidocaine