Reply to: Cervical plexus and greater occipital nerve blocks: controversies and technique update

2019 ◽  
Vol 45 (1) ◽  
pp. 89.1-89
Author(s):  
Manfred Greher ◽  
Bernhard Moriggl ◽  
Jens Børglum
Keyword(s):  
Cervical Plexus ◽  
Nerve Blocks ◽  
Occipital Nerve ◽  
Greater Occipital Nerve

Cervical plexus and greater occipital nerve blocks: controversies and technique update

2019 ◽  
Vol 44 (6) ◽  
pp. 623-626 ◽  
Author(s):  
Roy A Greengrass ◽  
Samer Narouze ◽  
Thomas F Bendtsen ◽  
Admir Hadzic
Keyword(s):  
Cervical Plexus ◽  
Nerve Blocks ◽  
Occipital Nerve ◽  
Greater Occipital Nerve

scholarly journals Sphenopalatine Ganglion versus Greater Occipital Nerve Blocks in Treating Post-Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Clinical Trial

2021 ◽  
pp. E443-E451
Keyword(s):  
Cesarean Section ◽  
Dural Puncture ◽  
Sphenopalatine Ganglion ◽  
Ganglion Block ◽  
Nerve Blocks ◽  
Neck Stiffness ◽  
Post Dural Puncture Headache ◽  
Occipital Nerve ◽  
Greater Occipital Nerve ◽  
Blood Patch

BACKGROUND: Despite being invasive, with serious complications, epidural blood patch (EBP) is still considered the gold standard therapy for Post Dural Puncture Headache (PDPH). The use of Peripheral nerve blocks for PDPH are studied here. OBJECTIVES: To investigate the efficacy of sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB) to relieve PDPH and its associated symptoms. STUDY DESIGN: Randomized comparative single-blind trial. SETTING: A University hospital. METHODS: Patients who received spinal anesthesia for elective cesarean section, and then developed PDPH during hospitalization or within 5 days after dural puncture were enrolled to receive GONB (n = 47) or SPGB (n = 46) for treatment of PDPH. GONB Group: Patients received bilateral GONB using 3 mL mixture of 2 mL lidocaine 2% plus 1 mL dexamethasone 4 mg on each side of occipital region. SPGB Group: Patients received bilateral SPGB using the same mixture in each nostril. Assessments included Numeric Rating Scale (NRS) for severity of headache at supine and sitting positions, nausea NRS, neck stiffness, need for EBP, and complications. RESULTS: The supine and sitting headache NRS scores significantly decreased at 30 minutes after blocks and throughout follow-up period in both groups (P < 0.000). Clinically significant drop of NRS to < 4 was reached earlier in GONB group. There was a significant difference between groups after 2 hours in supine and sitting headache NRS scores (P = 0.020 and 0.030, respectively); however, both treatments showed similar effectiveness from the third hour afterwards (P > 0.05). Both techniques were effective in relieving neck stiffness and nausea (P < 0.000), with no adverse effects. LIMITATIONS: A limitation to this study was the small sample size. CONCLUSIONS: GONB and SPGB are equally effective in relieving symptoms of PDPH. Both techniques are safe, simple, and less invasive than EBP. KEY WORDS: Cesarean Section, epidural blood patch greater occipital nerve block, post-dural puncture headache, sphenopalatine ganglion block

scholarly journals The Potential Roles of Cervical Plexus Abnormalities in Occipital Neuralgia: An Anatomic Variant Explored

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 139
Author(s):  
Mitchell H. Mirande ◽  
Heather F. Smith
Keyword(s):  
Clinical Significance ◽  
Degenerative Changes ◽  
Clinical Implications ◽  
Occipital Neuralgia ◽  
Cervical Plexus ◽  
Anatomical Variant ◽  
Occipital Nerve ◽  
Potential Source ◽  
Greater Occipital Nerve ◽  
Possible Cause

Occipital neuralgia (ON) is a condition defined as a headache characterized by paroxysmal burning and stabbing pain located in the distribution of the greater occipital nerve (GON), lesser occipital nerve (LON), or third occipital nerves (TON). This condition can be severely impairing in symptomatic patients and is known to have numerous etiologies deriving from various origins such as trauma, anatomical abnormalities, tumors, infections, and degenerative changes. This study reports four cases of a previously undescribed anatomical variant in which the (spinal) accessory nerve (SAN) fuses with the LON before piercing the sternocleidomastoid (SCM). The fusion of these two nerves and their route through the SCM points to a potential location for nerve compression within the SCM and, in turn, another potential source of ON. This anatomical presentation has clinical significance as it provides clinicians with another possible cause of ON to consider when diagnosing patients who present with complaints of a headache. Additionally, this study explores the prevalence of piercing anatomy of the LON and GAN and discusses their clinical implications.

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