Medical Minute: Regional Anesthesia for the Face

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April 22, 2015 by dailybolusoflr

By: Julie Rice, MD
*Great for laceration repair because local tissue distortion caused by lidocaine infiltration is limited.
1. Infraorbital Nerve Block
  • Midface anesthesia
  • Infraorbital foramen on the inferior boarder of the infraorbital ridge just under the pupil
  • Intraoral approach most common, inject 2-3 cc lidocaine adjacent to foramen with 25 or 27g needle
  • Be careful not to puncture globe

Please see video here by cutting and pasting this into your browser
2. Mental Nerve Block
  • Lower lip anesthesia
  • Great for injuries through lower lip (toddler vs. stairs or labret piercing catastrophe)
  • Mental foramen, similar technique to infraorbital nerve block with intraoral approach and injection of lidocaine adjacent to foramen
Please see video here by cutting and pasting this into your browser
https://youtu.be/7_uL6UmmAtc

3. Opthalmic(V1) block- supraorbital, supratrochlear and infratrochlear nerves where they emerge from the supraorbital notch
·     
  • Anesthesia to forehead
  • External approach with 25/27 g needle, inject 2-3 cc lidocaine adjacent to supraorbital notch
  • If this doesn’t work, infiltrate lidocaine from lateral to medial aspect of superior orbital rim to get all nerve branches
  • Hold gauze firmly against superior rim of orbit while infiltrating to prevent anesthetic from getting into soft tissue around upper eyelid.

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