II. Physiology: Ear sensory innervation
- Greater auricular nerve
- Lesser Occipital Nerve
- Auriculotemporal nerve
- Lesser Occipital Nerve
III. Indications
IV. Precautions
- Superficial temporal artery
- Positioned at anterior aspect of the ear with risk of puncture
- Aspirate while advancing needle
V. Technique: Field Block
- Prepare skin with Betadine, Hibiclens or Alcohol
- Draw up 12 cc Anesthetic (fill 10 cc syringe beyond marker)
- Lidocaine 1% without Epinephrine OR
- Bupivicaine 0.25% without Epinephrine
- Exercise particular caution around temporal artery (LAST Reaction risk)
- Block forms diamond shape encompassing ear
- Identify 2 injection sites
- Midline superior (1 cm above the ear, superior helix)
- Insert the needle and direct anteriorly
- Aspirate while advancing needle (identifies vascular puncture, esp. temporal artery)
- Inject 2.5 to 3 cc Anesthetic while withdrawing the needle (so needle tip is still within skin)
- Redirect needle posterioly
- Inject 2.5 to 3 cc Anesthetic while withdrawing the needle
- Insert the needle and direct anteriorly
- Midline inferior (1 cm below the ear)
- Repeat the same technique as for the superior injection
- Midline superior (1 cm above the ear, superior helix)
VI. Resources
- LacerationRepair.com (Brian Lin, MD)
VII. References
- Moy in Pfenninger (1994) Procedures, p. 145-55
- Warrington (2016) Crit Dec Emerg Med 30(10): 12-3
- Salam (2004) Am Fam Physician 69(3):585-90 [PubMed]