Ear Nerve Block

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