Nerve block: Auricular: Difference between revisions
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==Indications== | ==Indications== | ||
*Repair of lacerations | *Repair of [[lacerations]] | ||
*I+D of hematoma or abscess, or other painful procedures involving the external ear | *I+D of hematoma or [[abscess]], or other painful procedures involving the external ear | ||
==Contraindications== | ==Contraindications== | ||
*Infection at injection site | *Infection at injection site | ||
*Allergy to chosen anesthetic | *Allergy to chosen anesthetic | ||
*Coagulopathy | |||
==Equipment== | ==Equipment== | ||
Line 26: | Line 27: | ||
==Technique== | ==Technique== | ||
===Ring block=== | ===Ring block=== | ||
''Provides anesthesia to entire ear'' | |||
#Place patient in supine or sitting position | #Place patient in supine or sitting position | ||
#Disinfect skin at the base and superior aspect of ear using chosen antiseptic | #Disinfect skin at the base and superior aspect of ear using chosen antiseptic | ||
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#Redirect and advance needle posterior to the ear | #Redirect and advance needle posterior to the ear | ||
#Inject 2-3 mL anesthetic while withdrawing needle | #Inject 2-3 mL anesthetic while withdrawing needle | ||
===Auriculotemporal block=== | |||
''Provides anesthesia to helix and tragus'' | |||
#Disinfect skin with antiseptic | |||
#Insert needle just anterior and superior to tragus | |||
#Aspirate, slowly inject 3-4 mL anesthetic | |||
===Field block=== | |||
''Provides anesthesia to ear lobe and lateral helix'' | |||
#Disinfect skin with antiseptic | |||
#Insert needle behind the earlobe | |||
#Aspirate, slowly inject 3-4 mL anesthetic while advancing superiorly | |||
==Complications== | ==Complications== | ||
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==See also== | ==See also== | ||
[[Nerve and regional blocks (main)]] | *[[Nerve and regional blocks (main)]] | ||
==External links== | ==External links== | ||
==References== | ==References== | ||
<references/> | |||
[[Category: Procedures]] | [[Category:Procedures]] | ||
[[Category:ENT]] |
Revision as of 16:42, 9 October 2019
Background
- External ear innervated by four sensory nerves
- Greater auricular nerve
- Lesser occipital nerve
- Auricular branch of vagus nerve
- Auriculotemporal nerve
- Provides anesthesia to the entire ear without distorting anatomy
Indications
- Repair of lacerations
- I+D of hematoma or abscess, or other painful procedures involving the external ear
Contraindications
- Infection at injection site
- Allergy to chosen anesthetic
- Coagulopathy
Equipment
- Syringe, 5-10 mL
- Needle, 25-27 gauge
- Local anesthetic (e.g. lidocaine 1%, bupivacaine 0.25%)
- Antiseptic (e.g. Betadine, Chlorhexidine, Alcohol)
- Sterile gloves
- Sterile drape
- Gauze
Technique
Ring block
Provides anesthesia to entire ear
- Place patient in supine or sitting position
- Disinfect skin at the base and superior aspect of ear using chosen antiseptic
- Insert needle into the skin just inferior to the attachment of the earlobe to the head
- Advance needle just anterior to the tragus, aspirate while advancing
- Inject 2-3 mL of anesthetic while slowly withdrawing needle back to the original injection site
- Redirect and advance needle posterior and superior, aspirating while advancing
- Inject 2-3 mL anesthetic while withdrawing needle
- Remove needle and reinsert just superior to the attachment of the helix to the scalp
- Advance needle just anterior to the tragus, aspirate while advancing
- Inject 2-3 mL anesthetic while withdrawing needle toward to the original puncture site
- Redirect and advance needle posterior to the ear
- Inject 2-3 mL anesthetic while withdrawing needle
Auriculotemporal block
Provides anesthesia to helix and tragus
- Disinfect skin with antiseptic
- Insert needle just anterior and superior to tragus
- Aspirate, slowly inject 3-4 mL anesthetic
Field block
Provides anesthesia to ear lobe and lateral helix
- Disinfect skin with antiseptic
- Insert needle behind the earlobe
- Aspirate, slowly inject 3-4 mL anesthetic while advancing superiorly
Complications
- Infection
- Allergic reaction
- Hematoma
- Inadequate anesthesia
- Cannulation of superficial temporal artery (located medial to the ear, crosses over zygomatic arch)
- Hold firm pressure with gauze for at least 20-30 minutes