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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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The greater occipital nerve arises from the dorsal rami of the second cervical nerve and travels deep to the cervical musculature until it becomes subcutaneous slightly inferior to the superior nuchal line. It emerges on this line in association with the occipital artery, which is the most useful landmark for locating the greater occipital nerve ( Fig. 19-1 ).

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Figure 19-1  Occipital nerve block: anatomy and technique.


The most effective patient position for the greater occipital block is the sitting position, with the chin flexed on the chest. A short, 25-gauge needle is inserted through the skin at the level of the superior nuchal line to develop a “wall” of local anesthetic surrounding the posterior occipital artery. The artery is commonly found approximately one third of the distance between the external occipital protuberance and the mastoid process on the superior nuchal line. Injection of 3 to 5 mL of local anesthetic in this area produces satisfactory anesthesia.

Potential Problems.

The superficial nature of this block should make complications infrequent. In any event, it is important to ask the patient whether he or she has undergone any posterior cranial surgery because total spinal anesthesia has occurred after occipital nerve block in patients who have had such surgery.

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