Efficacy of bilateral greater occipital nerve block in postdural puncture headache: a narrative review

Nair, Abhijit; Kodisharapu, Praveen Kumar; Anne, Poornachand; Saifuddin, Mohammad; Christopher, Asiel; Rayani, Basanth Kumar

doi:10.3344/kjp.2018.31.2.80

Cited by 19 publications

(23 citation statements)

References 31 publications

(27 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…• Vasovagal syncope • Transient dizziness • Tenderness after injection • Hypersensitivity • Worsening of migraine headache after injection • Alopecia as a result of steroid addition 14 • Others like transient facial nerve palsy 15 In conclusion, an ultrasound-guided GON intervention is an effective intervention for managing headache disorder and its associated symptoms. Till now, this intervention has yielded satisfactory results, but further randomized controlled trials are required to support indications of GON…”

Section: Complications/adverse Effects O F Greater Occipital Nerve Inmentioning

confidence: 94%

Ultrasound-guided Greater Occipital Nerve Intervention: A Novel Technique for Diagnosis and Management of Headache Disorders

Chhabra¹,

Sharma²,

Lnu³

et al. 2019

Journal on Recent Advances in Pain

View full text Add to dashboard Cite

Greater occipital nerve (GON) intervention is indicated for managing different types of headache disorder including chronic migraine, occipital neuralgia, cervicogenic headache, and cluster headache. 1 The hypothesis behind using this intervention in headache management comes from the evidence of the transmission of sensory information to the fifth nerve nucleus neurons from both cervical and trigeminal fibers, thereby resulting in an antagonizing "wind-up-like effect". 2 In the past, landmark-guided GON intervention, based on anatomy, has been performed, which yielded variable results. The classical method of anatomical or landmarkguided GON intervention involves initial palpation of occipital artery at the level of the superior nuchal line. Once pulsations of occipital artery are felt, thumb is placed over it and negative aspiration injection is performed from medial to artery ( Fig. 1). Now various studies have revealed that ultrasound-guided GON intervention is the gold standard, which not only helps the interventionist to exactly localize the nerve but also increases the success rate of this intervention with even the smallest amount of the local anesthetics. On the contrary, ultrasonography (USG) does not compromise patient safety when compared with landmarkguided procedures. AnAtomy o f GreAter occipitAl nerveIt is the sensory branch of the dorsal rami of the second spinal nerve, i.e., C2. Along with the lesser occipital nerve, it supplies the skin involving C2 and some part of C3 dermatome, i.e., areas adjoining the vertex. 3 After exiting the second spinal nerve, it appears at the lower border of the obliquus capitis inferior muscle (OCIM). Thereafter, it parallels between the OCIM and the semispinalis capitis muscle (SsCM). At last, it terminates in relation to trapezius and sternocleidomastoid, i.e., either penetrates the trapezius muscle or it travels as sandwiched between the trapezius muscle and the sternocleidomastoid muscle. In the short-axis view, the GON is seen as a hypoechoic structure sandwiched between the SsCM dorsally and the OCIM ventrally. 4 UltrAsoUnd-GUided intervention• Place the patient in prone position with neck flexed on a head ring or pillow. • Adjust the knobology component on the USG machine in terms of depth of gain and field to improve the image resolution. • A high-frequency linear (10-12 MHz) USG probe is placed over the occiput to get a short-axis view. Image is adjusted, so that the external occipital protuberance lies in the midline.• Now probe is oriented in an oblique manner, so that medial part of the probe points toward the C2 spinous process, which can be identified as a bifid structure and the lateral part of probe is directed toward the transverse process of the C1 vertebrae. • Now move the probe downwards to visualize the short-axis view of atlas to locate its arch. • Move the probe further downward to the C2 level to obtain bifid spinous structure along with left and right tubercles. It confirms the axis vertebrae.

show abstract

Section: Complications/adverse Effects O F Greater Occipital Nerve Inmentioning

confidence: 94%

Ultrasound-guided Greater Occipital Nerve Intervention: A Novel Technique for Diagnosis and Management of Headache Disorders

Chhabra¹,

Sharma²,

Lnu³

et al. 2019

Journal on Recent Advances in Pain

View full text Add to dashboard Cite

show abstract

“…El bloqueo del ganglio esfenopalatino nasal (34)(35)(36) es un tratamiento reciente, descrito para cefalea postpunción, implica la inserción de cotonetes largos en la cavidad nasal y el depósito continuo de anestésico local, aunque esto se desconoce, podría ser un procedimiento generador de aerosoles, por lo tanto, debe evitarse en pacientes con sospecha o COVID-19 positivo. Otra opción complementaria del tratamiento médico en casos de cefalea postpunción podría ser el bloqueo del nervio gran occipital (GON) (37) , lo cual podría implicar un menor riesgo.…”

Section: Anestesia Neuroaxial Y Regionalunclassified

“…La parálisis diafragmática ocurre debido a los efectos inhibitorios de los anestésicos locales sobre el nervio frénico o sus raíces nerviosas de C3-5, por lo que se recomienda adoptar varios métodos para minimizar la aparición de parálisis diafragmática. Estos incluyen la modificación de la dosis de anestésico local a través del volumen y la concentración o el sitio y la técnica de inyección en un bloqueo interescalénico, o la realización de una técnica regional completamente diferente, como un bloqueo supraescapular o infraclavicular (37) .…”

Section: Anestesia Neuroaxial Y Regionalunclassified

Manejo perioperatorio del paciente con COVID-19

Garduño-López

Guido-Guerra

Guizar-Rangel

et al. 2020

Revista Mexicana De Anestesiología

View full text Add to dashboard Cite

2 ha puesto a prueba los sistemas de salud en toda su extensión a lo largo del mundo. Se desconoce el impacto del estrés quirúrgico y de la anestesia sobre la predisposición a una nueva infección por COVID-19, o la exacerbación de la infección en un paciente infectado por este virus que se va a operar. Aunque la mortalidad de COVID-19 está entre 1-5%, la mayoría de las muertes han ocurrido en pacientes de edad avanzada con afecciones cardiopulmonares subyacentes, la mayoría de ellos hipertensos, diabéticos y con obesidad, por lo cual, se debe poner especial atención en su manejo. La preparación y planeación perioperatoria cuidadosa es clave para lograr con éxito una adecuada atención clínica y mantener la seguridad del equipo de salud en un momento difícil y de alto riesgo. Un papel adicional del anestesiólogo, considerando que es el médico con mayor experiencia en el manejo de la vía aérea, consiste en apoyar a los servicios de emergencia para la intubación endotraqueal de los pacientes que requieren apoyo ventilatorio, siendo un procedimiento con recomendaciones de protección muy específicas. Por lo tanto, existe un compromiso como especialistas de conocer el tema a fondo y protegernos, así como al equipo de profesionales de la salud que se exponen salvando vidas durante esta contingencia. ABSTRACT. Currently, the SARS-CoV-2 pandemic has put health systems to the test throughout their world. The impact of surgical stress and anesthesia on predisposition to a new COVID-19 infection or exacerbation of the infection in a COVID-19 infected patient to be operated on is unknown. Although COVID-19 mortality is between 1-5%, most deaths have occurred in elderly patients with underlying cardiopulmonary conditions, most of them hypertensive, diabetic and obese, therefore, it should be specially attention in its handling. Carefull perioperative preparation and planning is key in successfully achieving adequate clinical care and maintaining the safety of the health team in a difficult and high risk moment. An additional role for the anesthesiologist, considering that he has the most experience in the management of the airway, is to support the emergency services for endotracheal intubation of patients who require ventilatory support, being a procedure with very specific protection recommendations. Therefore, there is a commitment as specialists, to know the subject thoroughly and protect ourselves along with the health team involved in saving lives during this contingency.

show abstract

“…In the most severe cases, epidural injection of fibrin glue or surgical repair of the dura is used [53]. Greater occipital nerve blockage is a very effective method that is technically easy to perform, it is minimally invasive, and with a low rate of neurological complications [54].…”

Section: Therapymentioning

confidence: 99%

Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

et al. 2019

View full text Add to dashboard Cite

Introduction. Post-dural puncture headache is classified as a secondary headache attributable to non-vascular intracranial disorders and belongs to the group of headaches caused by low cerebrospinal fluid pressure. Etiopathogenesis. The pathogenesis is not completely clear, but it is thought to be caused by the cerebrospinal fluid leak through the duct opening. Cerebrospinal fluid efflux leads to a decrease in intracranial pressure and stretching of the pain sensitive intracranial structures. A drop in intracranial pressure can cause compensatory cerebrovascular vasodilation, contributing to the onset of a headache. Diagnosis and Therapy. Post-dural puncture headache clinically presents as an orthostatic headache. In most cases, the diagnosis is made based on a typical clinical picture and it can be confirmed by magnetic resonance imaging and measurement of cerebrospinal fluid pressure. The condition is usually benign, most often with spontaneous recovery. The therapy involves conservative treatment, medications, as well as some invasive methods: epidural blood patches, blockage of the greater occipital nerve, and in most severe cases, epidural injection of fibrin sealant or surgical dural repair. Conclusion. Post-dural puncture headache is a common complaint in the clinical practice of neurologists and anesthesiologists. The prognosis is usually favourable, while the therapy may include conservative or invasive treatment procedures.

show abstract

Efficacy of bilateral greater occipital nerve block in postdural puncture headache: a narrative review

Cited by 19 publications

References 31 publications

Ultrasound-guided Greater Occipital Nerve Intervention: A Novel Technique for Diagnosis and Management of Headache Disorders

Ultrasound-guided Greater Occipital Nerve Intervention: A Novel Technique for Diagnosis and Management of Headache Disorders

Manejo perioperatorio del paciente con COVID-19

Post-dural puncture headache: Epidemiology, onset mechanisms, clinical symptoms, diagnosis and therapy

Contact Info

Product

Resources

About