Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection

Greher, Manfred; Moriggl, Bernhard; Curatolo, Michele; Kirchmair, Lukas; Eichenberger, Urs

doi:10.1093/bja/aeq052

Cited by 127 publications

(111 citation statements)

References 24 publications

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“…While the mean distance of GON lateral to midline on the right side was 13.4 ± 1.65 mm and 14.1 ± 2.07 mm on the left side. Greher et al 13 reported that the distance from the EOP to the GON was 17.4 mm (11.1-22.8 mm) in their cadaveric study. Shim 12 found the distance to be 23.1 ± 3.4 mm on the right and 20.5 ± 2.8 mm on the left from the EOP to the GON.…”

Section: Discussionmentioning

confidence: 89%

Surgical anatomy of greater occipital nerve and its relation to occipital artery

Sekily

Zedan

2015

Alexandria Journal of Medicine

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Introduction: The knowledge of the anatomy of greater occipital nerve and its relation to occipital artery is important for the surgeon. Blockage or surgical release of greater occipital nerve is clinically effective in reducing or eliminating chronic migraine symptoms. Aim: The aim of this research was to study the anatomy of greater occipital nerve (GON) and its relation to occipital artery. Also the use of these anatomical measures in local injection of the greater occipital nerve for treatment of migraine. Materials and methods: The study was carried out at the Faculty of Medicine, Alexandria University. The posterior neck and scalp of 25 cadaveric heads were dissected. GON was identified and measured relative to bony landmarks. Delineation of GON and occipital artery relationship was done. Twenty patients suffering from migraine diagnosed according to International Headache Society (IHS) criteria (HIS 2004) were treated using GON blockade. The landmark for GON injection was based on the anatomical study. Treatment was assessed using the visual analogue scale for migraine pain. Results: In the anatomical study, the GON was found in all specimens. The diameter of GON was measured at the lower border of inferior oblique, where it pierced SSC, and after its exit from trapezius muscle. The distance between the point where the GON pierced SSC inferior to the external occipital protuberance (EOP) and lateral to the midline was also measured. The GON was parallel to the occipital artery. The distance between GON and occipital artery was measured. In the clinical study, 20 patients suffering from migraine were treated with 1.5 ml of 0.5% bupivacaine using GON blockade. The landmark for GON injection was based on the anatomical study. For the right GON: the vertical location inferior to EOP ranged from 19.85 mm to 26.9 mm with a mean of 23.1 mm. The lateral location from EOP ranged from 11.03 mm to 14.65 mm with a mean of 13.4 mm. For the left GON: the vertical location inferior to EOP ranged from 16.89 mm to 29.5 mm with a mean of 22.1 mm. The lateral location from EOP ranged from 10.89 mm to 15.31 mm with a mean of 14.1 mm.

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Section: Discussionmentioning

confidence: 89%

Surgical anatomy of greater occipital nerve and its relation to occipital artery

Sekily

Zedan

2015

Alexandria Journal of Medicine

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“…Since the nerve can be relatively easily located medially to the palpable occipital artery along the superior nuchal line, a simple landmark approach with careful and frequent aspiration between injections is often suffi cient. However, an ultrasound-guided approach has been described [ 2 ].…”

Section: Block Techniquesmentioning

confidence: 99%

“…A recent cadaveric study compared two techniques of ultrasound guidance for greater occipital nerve block, using both the traditional block site and a selective approach at a proximal location where the nerve curls around the lower border of the obliquus capitis inferior muscle after emerging below the posterior arch of the atlas [ 2 ]. A transverse midline orientation is initially used to identify the external occipital protuberance.…”

Section: Current Literature In Ultrasoundguided Approachesmentioning

confidence: 99%

Occipital Nerve Blocks

Tsui

2016

Pediatric Atlas of Ultrasound- And Nerve Stimulation-Guided Regional Anesthesia

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“…In our clinic, we prefer GON blockade technique described by Greher et al using new anatomical landmark [22] (Figure 2). This new proximal technique has some important advantages over the classical Ultrasound guided chronic pain interventions one.…”

Section: Musculoskeletal Interventions In Chronic Painmentioning

confidence: 99%

Ultrasound guided chronic pain interventions (Part I)

Akkaya

Alptekin

Özkan

2015

Agri

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SummaryRecently, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy or computed tomography. Latest publications in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expand its applications in algology practice. This review highlights different applications of US in chronic pain conditions. Keywords: Chronic pain; nerve blocks; ultrasound. ÖzetSon zamanlarda rejyonal anestezi pratiğinde ultrasonografi (US) vazgeçilmez görüntüleme tekniği olarak yerini almıştır. Ultrasonografi ile kas/iskelet, periferik ve nöraksial bölgelerin kronik ağrılı patolojilerde çeşitli invaziv girişimler yapmak olasıdır. Bu girişimler diagnostik bloklar, radyofrekans uygulamaları ve nörolitik ajanların uygulamaları olarak özetlenebilirler. Algolojik girişimler esnasında US; hedef dokuların görüntülenmesinde, uygulanan ilacın yayılımında, çevredeki vasküler yapıların görün-tülenmesinde büyük kolaylıklar sağlar. Ayrıca US ile floroskopi veya bilgisayarlı tomografi uygulamaları esnasındaki radyasyon yayılımı söz konusu değildir. Kronik ağrı girişimlerinde US ile yayınlanan klinik çalışmalar umut vericidir. Ayrıca son yıllarda bu alandaki gelişmeler (ekojen iğneler, üç boyutlu US cihazları vd.) US'nin algoloji pratiğindeki kullanımının daha da yaygınlaşaca-ğını düşündürmektedir. Bu derlemenin amacı, US eşliğinde yapılan çeşitli kronik ağrı girişimlerini gözden geçirmektir.

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Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: a comparison of two selective techniques confirmed by anatomical dissection

Abstract: Our findings confirm that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2. This newly described approach superficial to the obliquus capitis inferior muscle has a higher success rate and should allow a more precise blockade of the nerve.

Cited by 127 publications

References 24 publications

Surgical anatomy of greater occipital nerve and its relation to occipital artery

Surgical anatomy of greater occipital nerve and its relation to occipital artery

Occipital Nerve Blocks

Ultrasound guided chronic pain interventions (Part I)

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