Abstract
The use of bupivacaine and other local anesthetics to perform peripheral nerve blocks is a mainstay in the management of refractory headaches and migraines. In this case report, a patient presented with transient facial nerve palsy shortly after receiving occipital nerve blocks for headaches. Patient’s symptoms self-resolved, and her symptoms were thought to be due to displacement and spreading of bupivacaine to the facial nerve. The spread of bupivacaine can be facilitated by tracking across fascial planes or nerve sheaths. Similar side effects have been seen in dental anesthesia, but there has only been one other report of such a presentation associated with occipital nerve blocks, and none in pediatric patients. Physicians should be aware of this rare complication with peripheral nerve blocks.
Highlights
Nerve blocks with medications such as bupivacaine, and other anesthetics is one of the treatment options of intractable headaches
A patient presented with transient facial nerve palsy shortly after receiving occipital nerve blocks for headaches
Similar side effects have been seen in dental anesthesia, but there has only been one other report of such a presentation associated with occipital nerve blocks, and none in pediatric patients
Summary
Nerve blocks with medications such as bupivacaine, and other anesthetics is one of the treatment options of intractable headaches. While many patients respond well to nerve blocks and adverse events are rare, this case report details a pediatric patient who developed transient unilateral face weakness shortly after treatment with peripheral nerve blocks. This appears to be a rare occurrence, and there is little reporting of this complication in the current literature, though similar events have been seen in dental anesthesia cases
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