Table 3

Common pitfalls and solutions for the safe administration of peripheral nerve blocks

Allergy to local anaesthetic or corticosteroidAlways enquire about previous reactions to local anaesthetic or allergies, that is, dental anaesthetic reaction. In case of anaesthetic allergy, patients can receive corticosteroid-only blocks, but this limits the procedure to greater/lesser occipital nerve blocks only
Pain during injectionApply an anaesthetic cream to the site before the injection. Use a fine gauge needle, avoiding lateral motions once the needle is inserted. Removal and re-insertion of the needle can help if the patient reports severe pain.
Bleeding from injection siteBleeding is usually minimal and applying pressure with a swab after the injection will suffice. Pre-existing bleeding disorders and anticoagulation use are relative contraindications and decisions about injecting these patients should be individualised depending on the benefits and risks.
Dizziness, light-headedness, vasovagal syncopePatients have occasionally reported transient light-headedness and dizziness post-procedure, which settles after a few hours.26 Administer the block with the patient in a reclined or decubitus position and advise that they avoid standing up for a few minutes after the block. Limit the number of nerves blocked in one session to reduce the total anaesthetic dose delivered.
Teratogenicity in pregnancyAnaesthetic-only blocks are considered safe and recommended throughout pregnancy.27 Corticosteroid nerve blocks are not recommended during pregnancy.
Alopecia, dermal atrophyThese are rare side effects of localised corticosteroid use reported in less than 2% of greater occipital nerve injections and can last for several months.24 28 Alert the patient to this potential aesthetic complication and refrain from using corticosteroids if patients report this adverse effect after initial use. Corticosteroids are used for the greater/lesser occipital nerve injection.