Nerve Block: Supraorbital

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Background

  • Supraorbital nerve innervates the ipsilateral upper eyelid, forehead, and anterior 1/3 of scalp
  • Nerve block provides regional anesthesia without distortion of soft tissue seen in local infiltration

Indications

  • Trauma or need to perform painful procedure on area innervated by supraorbital nerve

Contraindications

  • Infection overlying injection site
  • Previous allergic reaction to local anesthetic
  • Uncooperative patient
  • Distortion of anatomical landmarks

Equipment Needed

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

Procedure

  1. Obtain informed consent
  2. Place patient in supine position or seated
  3. Draw up 2-5cc of anesthetic into syringe
  4. Palpate the supraorbital foramen over the medial aspect of the supraorbital ridge
  5. Prep area
  6. Advance the needle towards foramen (5-10mm)
  7. Aspirate, and if no blood, inject 1-3 cc of anesthetic slowly
  8. Massage area for 10-15 seconds
  9. If block is unsuccessful, inject a line of anesthetic solution along the orbital rim laterally to medially to block all branches of the ophthalmic nerve

Complications

  • Bleeding/hematoma
  • Infection
  • Pain
  • Swelling of face/eyelid
  • Allergic reaction to anesthetic
  • Damage to nerves/vessels

See Also

References

  • Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014