Nerve block: auricular

Background

Dermatome distribution of the trigeminal nerve, also showing the sensory distribution of the great auricular, lesser occipital, and greater occipital nerves.

• 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

1. Place patient in supine or sitting position
2. Disinfect skin at the base and superior aspect of ear using chosen antiseptic
3. Insert needle into the skin just inferior to the attachment of the earlobe to the head
4. Advance needle just anterior to the tragus, aspirate while advancing
5. Inject 2-3 mL of anesthetic while slowly withdrawing needle back to the original injection site
6. Redirect and advance needle posterior and superior, aspirating while advancing
7. Inject 2-3 mL anesthetic while withdrawing needle
8. Remove needle and reinsert just superior to the attachment of the helix to the scalp
9. Advance needle just anterior to the tragus, aspirate while advancing
10. Inject 2-3 mL anesthetic while withdrawing needle toward to the original puncture site
11. Redirect and advance needle posterior to the ear
12. Inject 2-3 mL anesthetic while withdrawing needle

Auriculotemporal block

Provides anesthesia to helix and tragus

1. Disinfect skin with antiseptic
2. Insert needle just anterior and superior to tragus
3. Aspirate, slowly inject 3-4 mL anesthetic

Field block

Provides anesthesia to ear lobe and lateral helix

1. Disinfect skin with antiseptic
2. Insert needle behind the earlobe
3. 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

See also

• Nerve and regional blocks (main)

External links

Videos

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