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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
Equipment
- Syringe, 5-10 mL
- Needle, 25-27 gauge
- Local anesthetic (e.g. lidocaine 1%, bupivacaine 0.25%)
- Lidocaine with epinephrine may be used for regional block, but epi should not be used for direct infiltration of the ear
- 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
