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ULTRASOUND-GUIDED GREATER OCCIPITAL NERVE BLOCK AS A COMPONENT OF CHRONIC FACIAL PAIN TREATMENT(V2 AND V3 NEURALGIA TYPE)
Author(s):
PASZKOWSKA, M.*
Affiliations:
POMERANIAN ONCOLOGICAL CENTRUM ZACHODNIOPOMORSKIE CENTRUM ONKOLOGII ZCO, CHRONIC PAIN SURGERY, SZCZECIN, Poland
ESRA Academy. Paszkowska M. Sep 16, 2017; 196154; esra7-0311
Magdalena Paszkowska
Magdalena Paszkowska
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Abstract
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Background and Aims:

A 42 y.o. patient with chronic facial pain (left-sided, trigeminal nerve branch -V2 and branch -V3 neuralgia type) due to squamous papilloma outgrowing the lower lip and the buccal cavity and chronic respiratory insufficiency (lung infiltrative lesions, COPD, Castleman’s tumour in the mediastinum), oxygen-dependent; with malabsorption, cachexia, and a gastrostomy tube. Due to facial pain, NIV is impossible; adverse effects following Tramadol administration, on high paracetamol doses. The aim was to treat effectively chronic facial pain and enable Non Invasive Ventilation

Methods:

After locating the greater occipital nerve (C2, OCI-obliquus capitis inferior muscle) using ultrasound, 2% lidocaine was injected, 6 ml during the first and the second block and the third block, respectively. During the blocks, the features characteristic for greater occipital nerve block were observed – scalp numbness (greater and lesser occipital nerve innervation area) and additionally temporary facial numbness (V3 innervation area, less in the V2 one).

Results:

After the first block, a complete resolution of symptoms for two weeks was obtained, after the second block – a pain intensification, and after the third block – a pain resolution lasting 5 weeks (still could not feel pain). The patient is able to apply NIV. In addition, the patient takes Tegretol (600 mg/d) and buprenorphine 17.5 mcg/h transdermal patches, every 3 days.

Conclusions:

Occipital nerve block through an anatomical pathway linking C2 activation to the trigeminocervical complex (as a component of complex therapy) enabled effective facial pain treatment.




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