Nerve Block: Infraorbital: Difference between revisions
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==Background== | |||
*Infraorbital nerve innervates the ipsilateral lower eyelid, side of the nose, and upper lip | |||
*Regional blocks provide anesthesia without distorting soft tissues as in local infiltration | |||
==Indications== | ==Indications== | ||
Infraorbital block provides facial anesthesia to the lower eyelid, side of the nose, and upper lip for procedures (closer of lacerations, debridement) without distorting the soft tissues as seen with local infiltration | Infraorbital block provides facial anesthesia to the lower eyelid, side of the nose, and upper lip for procedures (closer of lacerations, debridement) without distorting the soft tissues as seen with local infiltration | ||
==Contraindications== | ==Contraindications== | ||
*Infection overlying injection site | |||
*Previous allergic reaction local anesthetic | |||
*Distortion of anatomical landmarks | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Local anesthesic | |||
*5-10 mL syringe | |||
*Blunt fill needle | |||
*25-27ga needle | |||
*Chlorhexidine or betadine | |||
*Gauze | |||
*Sterile gloves | |||
*Sterile drape | |||
==Procedure== | ==Procedure== | ||
===Intraoral approach=== | ===Intraoral approach=== | ||
#Place patient in supine position or seated | #Place patient in supine position or seated | ||
#draw up 2-5cc of anesthetic into syringe | #draw up 2-5cc of anesthetic into syringe | ||
#apply anesthetic soaked q-tip to the mucosa opposite the upper second premolar (bicuspid) for 1 minute allowing for topical anesthesia | #apply anesthetic soaked q-tip to the mucosa opposite the upper second premolar (bicuspid) for 1 minute allowing for topical anesthesia | ||
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===Extraoral Approach=== | ===Extraoral Approach=== | ||
#Place patient in supine position or seated | #Place patient in supine position or seated | ||
#draw up 2-5cc of anesthetic into syringe (avoid epinephrine as you are very close to the facial artery while doing the block via this approach) | #draw up 2-5cc of anesthetic into syringe (avoid epinephrine as you are very close to the facial artery while doing the block via this approach) | ||
#palpate the infraorbital foramen (step 5 above) | #palpate the infraorbital foramen (step 5 above) | ||
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===Field Block=== | ===Field Block=== | ||
*If the nerve block does not work you can do a field block which will generally achieve the same effect | |||
*Inject 5 cc of local anesthetic into the upper buccal fold in an arc like distribution and then massage into the area for a few seconds | |||
==Complications== | ==Complications== | ||
*Bleeding/hematoma | |||
*Infection | |||
*Inadvertent intravascular injection | |||
*swelling of face/eyelid | |||
*allergic reaction to anesthetic | |||
*damage to nerves/vessels | |||
==See Also== | ==See Also== | ||
*[[Nerve Blocks (Main)]] | *[[Nerve Blocks (Main)]] | ||
*[[Local Anesthetic Systemic Toxicity (LAST)]] | |||
== | ==References== | ||
<References/> | |||
[[Category:Procedures]] | [[Category:Procedures]] | ||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 10:48, 9 August 2015
Background
- Infraorbital nerve innervates the ipsilateral lower eyelid, side of the nose, and upper lip
- Regional blocks provide anesthesia without distorting soft tissues as in local infiltration
Indications
Infraorbital block provides facial anesthesia to the lower eyelid, side of the nose, and upper lip for procedures (closer of lacerations, debridement) without distorting the soft tissues as seen with local infiltration
Contraindications
- Infection overlying injection site
- Previous allergic reaction local anesthetic
- Distortion of anatomical landmarks
Equipment Needed
- Local anesthesic
- 5-10 mL syringe
- Blunt fill needle
- 25-27ga needle
- Chlorhexidine or betadine
- Gauze
- Sterile gloves
- Sterile drape
Procedure
Intraoral approach
- Place patient in supine position or seated
- draw up 2-5cc of anesthetic into syringe
- apply anesthetic soaked q-tip to the mucosa opposite the upper second premolar (bicuspid) for 1 minute allowing for topical anesthesia
- palpate the infraorbital foramen by having the patient look straight ahead and draw an imaginary line vertically from the pupil toward the inferior border of the infraorbital ridge, keep your finger on the foramen
- retract the cheek and introduce the needle into the mucosa ~ 0.5cm from the buccal surface
- advance the needle, keeping it parallel to the long axis of the bicuspid) until it is near the foramen (~1.5-2.5 cm)... do not advance too far as you may enter the orbit
- aspirate, and if no blood, inject 4-5 cc of anesthetic slowly
Extraoral Approach
- Place patient in supine position or seated
- draw up 2-5cc of anesthetic into syringe (avoid epinephrine as you are very close to the facial artery while doing the block via this approach)
- palpate the infraorbital foramen (step 5 above)
- prep the overlying skin with betadine
- insert the needle through the skin, subcutaneous tissue, and muscle
- aspirate, if no blood, inject anesthetic slowly (the tissue will swell)
- remove the needle and massage the area for 10-15 seconds
Field Block
- If the nerve block does not work you can do a field block which will generally achieve the same effect
- Inject 5 cc of local anesthetic into the upper buccal fold in an arc like distribution and then massage into the area for a few seconds
Complications
- Bleeding/hematoma
- Infection
- Inadvertent intravascular injection
- swelling of face/eyelid
- allergic reaction to anesthetic
- damage to nerves/vessels