To anesthetize portions of the face and ears

 Areas of distributions:

    Supraorbital and supratrochlear: Forehead

    Infraorbital: Upper lip, upper cheek, lateral portion of the nose, and anterior maxillary teeth

    Inferior alveolar: Lower jaw, lower lip, lower teeth, and anterior two-thirds of the tongue

    Mental: Lower jaw, lower teeth, anterior tongue, and floor of the mouth

    Auricular: External ear

CONTRAINDICATIONS

 Absolute Contraindications

    Anaphylaxis to local anesthetic agents

 Relative Contraindications

    Coagulopathy

    Infection at the injection site

    Uncooperative or obtunded patients

SUPPLIES

 25-gauge to 30-gauge needle

 Syringe

 Topical anesthetic (optional)

    Eutectic mixture of local anesthetics (EMLA), 20% benzocaine, or 5% to 10% lidocaine ointment can be used to decrease the pain of needle insertion

 Bicarbonate (optional)

    1:10 dilution with injectable anesthetic to decrease the pain of infiltration

 Anesthetic agent

    Lidocaine 1% to 2%

       Onset of action: 4 to 10 minutes

       Duration of action: 1 to 2 hours

       Maximum one time dose: 4.5 mg/kg

    Bupivacaine 0.25%

       Onset of action: 8 to 12 minutes

       Duration of action: 4 to 8 hours

PREPARATION

 Position patient and adjust lighting for optimal visualization

 Apply topical local anesthetic

 Prepare nonmucosal injection sites with povidone–iodine solution or chlorhexidine

 Use sterile gloves

LANDMARKS AND TECHNIQUES

 Forehead Nerve Block (Supraorbital and Supratrochlear Nerve Blocks)

    Locate the supraorbital notch which is at the intersection of the superior edge of the orbit and a vertical line through the middle of the pupil when the eyes are looking forward

    Insert the needle slightly superior and medial to the supraorbital notch and inject 2 to 4 mL of anesthetic

    Move 0.5 to 1.0 cm medially and inject an additional 2 to 4 mL of anesthetic to block the supratrochlear nerve (FIGURE 80.1)

 Infraorbital Nerve Block

    Locate the infraorbital foramen which is at the intersection of the inferior edge of the orbit and a vertical line through the middle of the pupil when the eyes are looking forward

    Extraoral or intraoral approaches can be used

       Extraoral

         Insert the needle 1 cm below the infraorbital foramen and inject 2 to 4 mL of anesthetic

       Intraoral

         Place one finger on the infraorbital foramen and retract the upper lip

         Identify the first maxillary premolar and insert the needle into the mucobuccal fold with the bevel facing the bone

         Advance the needle toward the apex of the tooth or 1 cm below the infraorbital foramen

         Take caution to avoid entering the orbit or the infraorbital foramen. If the patient feels paresthesias, retract the needle.

         Inject 2 to 4 mL of anesthetic

 Mental Nerve Block

    Locate the mental foramen which lies in the plane of the supraorbital and infraorbital foramina (see above) at the apex of the lower second premolar

    Extraoral or intraoral approaches can be used (FIGURE 80.2)

       Extraoral

         Insert the needle 1 cm inferolateral to the foramen

         Inject 2 to 4 mL of anesthetic

       Intraoral

         Retract the patient’s lower lip

         Locate the space between the premolar and molar teeth

Related posts:

Delayed Sequence Intubation Reduction of Nursemaid’s Elbow (Radial Head Subluxation) No Desat: Maximally Aggressive Preoxygenation Elbow Arthrocentesis Episiotomy Gastroesophageal Balloon Tamponade and the Sengstaken–Blakemore Tube