Occipital osteomylelitis and epidural abscess after occipital nerve block: A case report

Abstract

Occipital neuralgia is a paroxysmal jabbing pain in the distribution of the greater or lesser occipital nerves accompanied by diminished sensation in the affected area. Occipital nerve block is a common diagnostic and therapeutic tool used in the course of occipital neuralgia and is considered a safe treatment with few localized adverse events. Occipital nerve block is also indicated for cervicogenic and cluster headache and is often used as a rescue treatment for headaches not responding to conventional therapies. We describe a case of epidural abscess formation 16 days following occipital nerve block in a patient with no underlying medical conditions. This case report emphasizes the importance of strict aseptic technique to reduce infection rates in patients undergoing this procedure, despite the overall safety of occipital nerve block. Clinicians must remain aware of acute and late complications arising postprocedure for the safe practice of this technique. RÉSUMÉ La névralgie occipitale est une douleur lancinante paroxystique dans la distribution des nerfs du grand ou du petit occipital qui s'accompagne d'une diminution des sensations dans la zone affectée. Le bloc du nerf occipital, un outil diagnostique et thérapeutique communément utilisé dans le cadre d'une névralgie occipitale, est considéré comme un traitement sécuritaire qui n'entraine que peu d'effets indésirables localisés. Le bloc du nerf occipital, également indiqué pour traiter la céphalée cervicogénique et la céphalée vasculaire de Horton, est souvent utilisé en tant que traitement de secours pour les céphalées qui ne répondent pas aux thérapies conventionnelles. Nous décrivons un cas de formation d'un abcès épidural 16 jours après le bloc du nerf occipital chez un patient sans affection médicale sous-jacente. L'étude de cas met l'accent sur l'importance d'une stricte conformité aux techniques d'asepsie afin de réduire les taux d'infection chez les patients soumis à cette procédure, malgré le caractère sécuritaire du bloc du nerf occipital. Les cliniciens doivent demeurer vigilants quant aux complications aigues et tardives qui peuvent survenir après la procédure afin d'appliquer cette technique de manière sécuritaire.

Narrative review of peripheral nerve blocks for the management of headache

“…23 Finally, one patient was reported to have developed a focal abscess and occipital osteomyelitis in the location of two recently performed GON blocks containing both anesthetic and corticosteroid. 104 Subcutaneous abscesses are a known risk for peripheral nerve blocks, 105 emphasizing the need for aseptic technique.…”

“…Skull base abnormalities, such as a previous posterior fossa craniotomy, have been associated with post‐injection loss of consciousness 102 and coma, 103 and are considered a contraindication for landmark‐based occipital nerve blocks 23 . Finally, one patient was reported to have developed a focal abscess and occipital osteomyelitis in the location of two recently performed GON blocks containing both anesthetic and corticosteroid 104 . Subcutaneous abscesses are a known risk for peripheral nerve blocks, 105 emphasizing the need for aseptic technique.…”