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#35970 Greater occipital nerve block: an opioid sparing alternative
  1. Jorge Carteiro1,
  2. Beatriz Soares2 and
  3. Idalina Rodrigues1
  1. 1Anestesiologia, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
  2. 2Anestesiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal


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Background and Aims This clinical case reports the effectiveness of the greater occipital nerve block (GON-block) in controlling postoperative pain in an 85-year-old man who underwent excision of a basal cell carcinoma in the occipital region and reconstruction with a bilobed flap. The GON block is performed by injecting local anesthetic close to the greater occipital nerve and it can be performed relatively quickly, simply and effectively. The available literature describes the efficacy of this block in the relief of cervicogenic headache, occipital neuralgia and migraine. However, evidence of its analgesic effectiveness in surgeries of the scalp of the occipital region is scarce.

Methods 85-year-old man, physical status ASA II. For the aforementioned surgery, he underwent combined anesthesia (balanced general anesthesia and GON blockade with 4 ml of Ropivacaine 7.5mg/ml, guided by ultrassound), with no surgical or anesthetic complications to be recorded. Postoperatively, we opted for a multimodal analgesia strategy with Paracetamol 1000mg IV 8/8h and Tramadol 100 mg IV as needed (maximum 8/8h). Pain intensity was evaluated using the numeric pain scale at 3, 5, 8, 12 and 24 hours.

Results In every evaluation the patient reported pain ≤ 1. Tramadol administration was never necessary.

Conclusions This clinical case suggests the effectiveness of this block in controlling postoperative pain in a patient who underwent surgery for the scalp in the occipital region. We also highlight the blockade’s apparent opioid-sparing effect. Further studies are required in order to demonstrate this block’s full potential.

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