You have now completed the e-course about the expert ultrasound guided peripheral nerve blocks

You have fulfilled the following learning objectives:

– Understanding the basic anatomy and sonoanatomy of the expert nerve blocks

– Knowing how to perform each of the expert nerve blocks

– Knowing about the pitfalls

Now you are ready to join the hands-on training

The greater occipital nerve runs very close to the vertebral artery. The artery should be identified with color Doppler.

Place the patient prone with the neck exposed.

Place a linear high-frequency probe in the axial plane across the external occipital protuberance.

Parallel shift the probe caudad to the bifid spinous process of C2. Move the probe lateral to identify the obliquus capitis inferior muscle and rotate the probe slightly to be parallel to the long axis of the muscle.

Visualize the greater occipital nerve on top of the obliquus capitis inferior muscle (see next page).

Insert the needle from the lateral end of the probe and advance the needle tip until it is in touch with the target nerve.

Inject 0.5 mL of local anaesthetic perineurally.

Greher M, Moriggl B, Curatolo M, Kirchmair L, Eichenberger U: Sonographic visualization and ultrasound-guided blockade of the greater occipital nerve: A comparison of two selective techniques confirmed by anatomical dissection.
British J Anaesth 104(5): 637-42 (2010)

The greater occipital nerve is visualized on top of the obliquus capitis inferior muscle.

The vertebral artery should be identified with color Doppler.

For the lumbar medial branch block the local anaesthetic is injected in the groove between the superior margin of the transverse process and the adjacent superior articular process.

Finlayson RJ, Gupta G, Alhujairi M, Dugani S, Tran de QH: Cervical medial branch block: A novel technique using ultrasound guidance. Reg Anesth Pain Med 37(2): 219-23 (2012)

Shim JK, Moon JC, Yoon KB, Kim WO, Yoon DM: Ultrasound-guided lumbar medial-branch block: A clinical study with fluoroscopy control. Reg Anesth Pain Med 31: 451-54 (2006)

The greater occipital nerve curls around the lower border of the obliquus capitis inferior muscle. It is attached to the bifid spine of the axis (C2) and to the transverse process of the atlas (C1).

The greater occipital nerve (GON) is the medial branch of the dorsal primary ramus of the second cervical nerve.

The GON innervates the muscles of the posterior neck: The semispinalis capitis and the multifidus cervicis. It also supplies cutaneous branches to the posterior scalp and meningeal branches to the posterior cranial fossa. And it supplies pain and proprioceptive branches for the first cervical nerve for innervation of the suboccipital muscles.

Diagnostic and therapeutic block for migraine and cluster headache.