Kocaeli Med J. 2024; 13(3): 224-226 | DOI: 10.5505/ktd.2024.01069

Local Anesthesia Systemic Toxicity After Greater Occipital Nerve + Third Occipital Nerve Block

Mehmet Yýlmaz
Department of Anesthesiology and Reanimation, Kocaeli City Hospital, Kocaeli, Turkey

Cervicogenic headache (CH) is a headache associated with greater occipital nerve (GON) and/or third occipital nerve (TON). GON and/or TON block is frequently preferred in cases of CH, which have resistance to medical treatment. In this case report, we aimed to present a case with systemic toxicity of local anesthesia, following GON+ TON block due to CH. A 34-year-old female weighing 70 kg with ASA I risk classification, underwent a block of GON+ TON for cervicogenic headache treatment. The block has performed with 2.5 ml 0.5% bupivacaine + 8 mg dexamethasone + 0.5 ml saline mixture after being assured that there was no blood or cerebrospinal fluid in negative aspiration under ultrasonography (USG). In the first minute after the procedure, dysarthria and perioral numbness have developed. A 10% lipid solution has started for treatment. We concluded that the use of USG and frequent negative aspiration in peripheral block applications did not eliminate the risk of inadvertent intravascular injection of the local anesthetic agent. Besides, we believe that the risk of inadvertent intravascular injection has increased in procedures in the cervical region where vascular structures are excessive and close to the skin surface.

Keywords: cervicogenic headache, greater occipital nerve block, third occipital nerve block, local anesthesia systemic toxicity

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Büyük Oksipital Sinir + Üçüncü Oksipital Sinir Bloðu Sonrasý Geliþen Lokal Anestezi Sistemik Toksisitesi

Mehmet Yýlmaz
Anesteziyoloji ve Reanimasyon Kliniði, Kocaeli Þehir Hastanesi, Kocaeli,Türkiye

Servikojenik baþ aðrýsý (CH), büyük oksipital sinir (GON) ve/veya üçüncü oksipital sinir (TON) ile iliþkili bir baþ aðrýsýdýr. Týbbi tedaviye direnç gösteren CH vakalarýnda GON ve/veya TON bloðu sýkça tercih edilmektedir. Bu vaka raporunda, CH nedeniyle GON+ TON bloðu sonrasý lokal anestezinin sistemik toksisitesi olan bir vakayý sunmayý amaçladýk. ASA I risk sýnýflandýrmasýna sahip, 70 kg aðýrlýðýnda, 34 yaþýnda bir kadýn hasta, servikojenik baþ aðrýsý tedavisi için GON+ TON bloðu uygulandý. Blok, ultrasonografi (USG) eþliðinde negatif aspirasyonda kan veya serebrospinal sývý olmadýðý doðrulandýktan sonra, 2.5 ml %0.5 bupivakaine, 8 mg deksametazon ve 0.5 ml salin karýþýmý ile gerçekleþtirildi. Ýþlem sonrasý ilk dakikada, perioral bölgede uyuþukluk ve dizartri geliþti. Tedavi için %10 lipid çözeltisi baþlanmýþtýr. Periferik blok uygulamalarýnda USG kullanýmý ve sýk negatif aspirasyonun, lokal anestezik ajanýn yanlýþlýkla intravasküler enjeksiyon riskini ortadan kaldýrmadýðý sonucuna vardýk. Ayrýca, vasküler yapýlarýn fazla olduðu ve cilt yüzeyine yakýn olduðu servikal bölgedeki iþlemlerde yanlýþlýkla intravasküler enjeksiyon riskinin arttýðýna inanmaktayýz.

Anahtar Kelimeler: servikojenik baþ aðrýsý, büyük oksipital sinir bloðu, üçüncü oksipital sinir bloðu, lokal anestezi sistemik toksisite

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