Position and anatomical landmarks
Infiltration of the greater and lesser occipital nerves is performed according to the anatomical landmarks described by Vital and Becser (see fFgure 1).
Figure 1: Anatomical landmarks of the Nervus Occipitalis Major and Minor for infiltration according to Vital and Becser.
The surrounding area is disinfected and covered with sterile drapes. A needle (22-G) is inserted (under ultrasound guidance) until there is contact with bone. The location of the nerve is confirmed when the patient experiences reproducible paresthesia in the occipital skin area of the nerve. The needle is slightly withdrawn and bupivacaine 0.25% with 20 mg of methylprednisolone is injected (in 2 ml).
- The most serious complication of the injection is infection.
- Small subcutaneous bleedings may result in a temporary increase in pain after the injection.