Paraspinous Cervical Block

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Please use your clinical judgement and note that this is not necessarily standard practice in NZ.

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Indication

This can be used for all types of headache, from tension type/migraine headaches, to orofacial/dental pain, to meningitis. Also for face pain

Landmark the C7 spinous process, which is usually the most prominent one.
Mark a point 1 inch lateral to the spinous process on each side, basically in the belly of the trapezius muscle overlying the transverse process.
Clean the area with alcohol swab.
Raise a wheal using lidocaine.
With patient in a sitting position and head held upright, insert a 25 gauge, 1.5 inch needle angled parallel to the floor. The needle should be nearly buried. Aspirate before injecting to ensure you are not in a vessel and slowly inject 1.5 cc of bupivacaine.
Massage the area
Remove needle and dress wound.

this area is pretty much all muscle, with the trapezius, levator scapula, splenius capitis and splenius cervicis all in that area.
If you do hit a vascular structure, it will usually be a vertebral vein, but rarely could be a vertebral artery. However, this is unlikely because it is deeper and protected by the foramen transversarium. If you are injecting over the transverse process, that will further protect you from hitting a vascular structure.

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