To begin, prepare the infiltration mixture for nerve blocking and transfer it into a five-milliliter syringe with a 30-gauge needle. Ask how the patient is feeling. After positioning the patient, identify the pit between the lateral edge of the proximal trapezius and the medial edge of the sternocleidomastoid muscle insertion below the nuchal line, and palpate the occipital artery passage above the nuchal line.
Using a 10-megahertz doppler, confirm the occipital neurovascular bundle position below the nuchal line. As the patient is seated upright, palpitate to identify the most tender point within the area. Prior to injecting, perform gentle aspiration with the syringe to prevent intravascular injection.
Mark the incision site with a two to three-centimeter oblique line across the tender area. With a surgical shaver, shave the marked area and one centimeter around it. Then, using a sterile cloth, drape the instrumentation table with laminar flow.
After administering local anesthesia to the patient, using a No.15 surgical blade, make an oblique, beveled incision measuring 2.5 to 3.5 centimeters. Utilizing a scalpel, incise the superficial layer of the nuchal line and dissect with the dissection scissors to expose the greater occipital nerve, occipital artery, and lymph nodes. Using dissection scissors, create the space following the greater occipital nerve meticulously along all points of possible compression, and perform proximal release of the inferior fascia of the trapezius muscle, semispinalis muscle fascia, and distal nuchal line fibers.
Employing Hudson surgical forceps, carefully reposition or remove the occipital artery and lymph nodes in contact with the nerves. Then, gently disengage the adventitial and periarterial tissues abundant in afferent and efferent autonomic nervous system fibers. Using a 30-gauge needle, spray 1%lidocaine with epinephrine directly on the nerve branches to block them.
Ask the patient to move the head and talk to confirm complete decompression. Finally, using 5-0 nylon sutures, close the incision with single stitches. Apply moisture-permeable spray dressing and sterile gauze on the site, and tape it carefully.
Ask how the patient is feeling after the procedure. After surgical decompression, chronic pain days experienced by the patients decreased 5.8 times and the pain crisis days per month decreased 5.1 times. Background pain intensity decreased 5.2 times in patients after the surgery, and pain intensity peaks during crises decreased 4.2 times.
