Fig. 17.1
Occipital nerve anatomy
Fig. 17.2
VHVS and MRI images capturing the expected location of the greater occipital nerve
17.2.1 Patient Positioning
Supine with head turned to the contralateral direction.
The head can be tilted forward slightly to expose the prominent nuchal ridge of bone at the posterior base of the skull.
Can be completed with the patient prone in preparation for surgical position.
17.2.2 Landmarks and Surface Anatomy (Fig. 17.3)
Fig. 17.3
Surface landmarks for greater and lesser occipital nerve blocks. SCM sternocleidomastoid muscle
Greater occipital nerve: The nerve is typically located lateral (1–2 cm) and inferior (1–2 cm) to the external occipital protuberance. In adults, it is found one-third of the distance from the external occipital protuberance to the mastoid process [1], which will typically locate the lateral border of the insertion of the erector muscles of the neck. Alternatively, the nerve can be located directly medial to the easily palpated occipital artery.
Lesser occipital nerve: This nerve is located lateral to the greater occipital nerve (approximately 2.5 cm in adolescent patients), along the inferior nuchal line.
17.2.3 Needle Insertion Technique (Figs. 17.4 and 17.5)
Fig. 17.4
Surface anatomy and needle insertion for greater occipital nerve block
