Occipital Nerves Decompression for Migraine Headache

By Dr. Kevin Han

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GLOVES: 6.5 Micro Indicator/6.5 Micro 

PREP: BETADINE PAINT, HAVE COMB ON STANDBY, 2 INCH SILK TAPE FOR HAIR PARTING. Dr. Han WILL TRIM HAIR ON BACK OF HEAD WITH CURVED MAYO SCISSORS, THEN TAPE HAIR WITH 2” SILK, Razor Available as well, THEN INJECT LOCAL.  HAVE 2” SILK CUT IN STRIPS PRIOR TO PATIENT ENTERING THE ROOM. 

POSITION:  Regular OR Bed, PRONE ON GEL ROLLS WITH PRONE HEADREST.  REMOVE MATTRESS PAD FROM HEAD OF BED.  PLACE LONG SHEET ON GEL ROLLS TO PAPOOSE ARMS.  FOAM UNDER KNEES, 1 PILLOWS UNDER LOWER LEGS.  BOTH ARMS TUCKED WITH FOAM, SECURE WITH BEDSTRAP OR SILK TAPE.  DOESN’T TURN BED FOR THIS PROCEDURE.

DRAPE – 4 TOWELS, DOWN SHEET, SPLIT SHEET, UP SHEET (FOR IV POLES)

MEDICATIONS: INJECTS LOCAL 10ML IN 10ML CONTROL SYRINGE (0.5% MARCAINE WITH EPI) BEFORE

PREP AND 20ML AT END OF CASE ON BACK TABLE.  SURGI-Lube Off the Field and on the Field.

INSTRUMENTS: Plastic Surgery Tray, Heiss Retractor ARMY NAVY RETRACTORS, DOUBLE WIDE SKIN

HOOKS (2), #3 KNIFE HANDLES (2), LANGENBACH RETRACTOR (1), FRAZIER SUCTION TIP (MAKE SURE FRAZIER TIP HAS A HOLE), STRAIGHT MAYO SCISSORS, CURVED MAYO SCISSORS, MOSQUITOS (2)

EQUIPMENT:  BOVIE, BIPOLOAR FOOTPEDAL,SCDS

SUPPLIES:  HEAD AND NECK PACK

Colorado Bovie Tip (OPEN)

BIPOLAR CORD (OPEN)

MAGNETIC PAD (GREEN REUSABLE PAD)

SKIN STAPLER (OPEN)

Small MULTIPLE CLIP APPLIER (AVAILABLE)

SUTURES: FOR UNILATERAL CASES OPEN ONE OF EACH, WHILE FOR BILATERAL OPEN TWO OF EACH LISTED SUTUTES

4-0 CHROMIC SH (OPEN) (2)

3-0 CHROMIC SH (OPEN) (2)

3-0 MONOCRYL PS-2 (OPEN) (2)

DRESSINGS:  BACITRACIN OINTMENT ONLY ( Give left over tube to patient to take home).         

NOTES: BOVIE @ CUT 20/COAG 20 BLEND 3, BIPOLAR @ 20 (ALL @ FOOT OF BED). TURN VOLUME ALL THE WAY DOWN ON BOVIE AND BIPOLAR. 

INSTRUMENTS TO BE KEPT ON MAYO STAND:

  • MARKING PEN (AVAILABLE)
  • Surgi-Lube IN A CUP AND BOVIE FORCEPS
  • 15 BLADE ON A KNIFE HANDLE
  • TWO DOUBLE HOOKS
  • GUARDED BOVIE TIP or Colorado Bovie Tip
  • DULL WEITLANDER RETRACTOR
  • TENOTOMY SCISSOR
  • HEMOSTAT
  • CRILE DOUBLE ENDED RETRACTOR
  • OBWEGESER RETRACTOR
  • SUTURE SCISSOR
  • BIPOLAR BLUE 4”