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Anatomy of the greater occipital nerve block in infants

Lané Prigge1,2, Albert N van Schoor2, Adrian T Bosenberg3

  • 1Department of Anatomy, School of Medicine, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa.

Paediatric Anaesthesia
|July 5, 2019
PubMed

Insights

A simple technique for pediatric greater occipital nerve blocks was developed. The greater occipital nerve is located approximately 23 mm from the external occipital protuberance in infants, medial to the occipital artery.

Area of Science:

  • Pediatric Anesthesiology
  • Neuroanatomy
  • Surgical Anatomy

Background:

  • Greater occipital nerve blocks are indicated for pain management in children undergoing posterior fossa craniotomies and for occipital neuralgia.
  • The greater occipital nerve originates from the C2 spinal nerve and innervates the posterior scalp, running alongside the occipital artery.

Purpose of the Study:

  • To develop a straightforward technique for performing greater occipital nerve blocks in pediatric patients.
  • To evaluate the anatomy of the greater occipital nerve and its relationship with the occipital artery in the occipital region for procedural guidance.

Main Methods:

  • Dissection and exposure of the greater occipital nerve and occipital artery in six formalin-fixed infant cadavers.
  • Measurement of distances between the nerve and bony landmarks, including the external occipital protuberance.
  • Evaluation of the anatomical relationship between the greater occipital nerve and occipital artery at the trapezius muscle hiatus.

Main Results:

  • The greater occipital nerve is located approximately 22.6 mm from the external occipital protuberance in infants.
  • A strong correlation (0.97) was found between this nerve's distance from the protuberance and the width of the medial three fingers at the proximal interphalangeal joint (20.4 mm).
  • The occipital artery was found lateral to the greater occipital nerve in 83.3% of specimens at the trapezius muscle hiatus.

Conclusions:

  • A reliable landmark for pediatric greater occipital nerve blocks is approximately 23 mm from the external occipital protuberance, medial to the occipital artery.
  • This distance can be easily estimated using the width of the patient's medial three fingers at the proximal interphalangeal joint.
Abstract

Keywords:
anatomicalanesthesiachild painoccipital arteryregional

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