Nerve Block: Infraorbital

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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

  1. allergic reaction to the type of anesthesia you are going to administer
  2. non-cooperative patient
  3. overlying skin infection
  4. distortion of anatomical landmarks

Equipment Needed

  1. local anesthesia
    1. lidocaine 1% (lasts 30-60 minutes or longer if given with epi, rapid onset of 4-6 minutes)
    2. Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
  2. 18 gauge needle to draw up anesthetic
  3. 1.5 inch 25 or 27 gauge needle
  4. 6cc syringe
  5. gauze pads
  6. gloves
  7. q-tip
  8. betadine

Procedure

Intraoral approach

  1. Place patient in supine position or seated
  2. Obtain informed consent
  3. draw up 2-5cc of anesthetic into syringe
  4. apply anesthetic soaked q-tip to the mucosa opposite the upper second premolar (bicuspid) for 1 minute allowing for topical anesthesia
  5. 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
  6. retract the cheek and introduce the needle into the mucosa ~ 0.5cm from the buccal surface
  7. 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
  8. aspirate, and if no blood, inject 4-5 cc of anesthetic slowly

Extraoral Approach

  1. Place patient in supine position or seated
  2. Obtain informed consent
  3. 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)
  4. palpate the infraorbital foramen (step 5 above)
  5. prep the overlying skin with betadine
  6. insert the needle through the skin, subcutaneous tissue, and muscle
  7. aspirate, if no blood, inject anesthetic slowly (the tissue will swell)
  8. remove the needle and massage the area for 10-15 seconds

Field Block

  1. if the nerve block does not work you can do a field block which will generally achieve the same effect
  2. 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

  1. bleeding
  2. infection
  3. pain
  4. needle fracture
  5. swelling of face/eyelid
  6. hematoma
  7. allergic reaction to anesthetic
  8. damage to nerves/vessels
  9. failure to achieve anesthesia

See Also

Source

emedicine