Facial blocks

[BobBarker]

Advertisement - Members don't see this ad

I have been doing more facial blocks. Supratrochlear/orbital, auriculotemporal primarily. Very fun to take the chronic headache away in a minute. Anyone else do these routinely?

 

[deleted131481]

I have been doing more facial blocks. Supratrochlear/orbital, auriculotemporal primarily. Very fun to take the chronic headache away in a minute. Anyone else do these routinely?

Funny you ask I was just thinking earlier this week after one of my patients of doing these 2 if someone comes in with an acute or chronic migraine. In fellowship we often did occipital block but not the other two for some reason.

What did you use? Was just planning 1-2cc marcaine.

 

[BobBarker]

Just lido 1%. Marcaine has gotten really expensive.

 

[callmeanesthesia]

I was lucky enough to I get to do quite a few scalp blocks in residency - some for awake cranis, and some just to blunt the hemodynamics effects of pinning the head. I did do a supraorbital/supratrochlear and occipital at the request of neurology for a patient admitted for headache. The occipital lasted beyond the local effect but the supraorbital/supratrochlear didn’t.

Sphenopalatine is usually my go to for acute migraine. I do the occasional occipital block for occipital area headache, but not usually the other nerves. You find it to actually have benefit for chronic headache? What kind? Also, what do you bill for? Medicare will pay for occipital nerve blocks but private insurers don’t, at least in my area, and I’m not even sure about coding for the others.

 

[BobBarker]

I think I did peripheral nerve block NOS. It probably doesn’t pay anything. Most of these patients don’t have true migraine. For true migraine, I am doing SPG like you.

 

[Ferrismonk]

I do them. Greater/Lesser Occipital nerves, supraorbital, infraorbital, auriculotemporal, etc.

Greater has it's own code
Lesser is Peripheral nerve
Others count as Trigeminal branches so use trigeminal nerve code

They're super easy and take 2 seconds.

I also do SPG periodically.

 

[pmrmd]

Why do these blocks? Do you guys really think this is the source of the pain? It seems like you’re sticking someone just stick them.

 

[Ducttape]

I do think GON and SPG are worth doing.

I did some supraorbitals, some dental blocks for temporary relief.

I tell them "its a break for a few hours or a day, nothing more"

 

[RoloTomassi]

I have been doing more facial blocks. Supratrochlear/orbital, auriculotemporal primarily. Very fun to take the chronic headache away in a minute. Anyone else do these routinely?

What kind of duration are you getting with these, and how frequent do you repeat?

 

[BobBarker]

I just started the past 3 months. None of them are back to baseline yet but some are only like 40% improved at 2m

 

[myrandom2003]

In about 6mo you will likely be posting about the Rf of those nerves 🙂

 

[BobBarker]

I worry about thermal that close to the epidermis. Are you pulsing them?

 

[Crybaby]

I’ve wondered about cryi like Iovera for these. Anyone else?