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PEM Pearls: Regional Facial Nerve Blocks

2018-01-21T21:11:01+00:00

facial nerve blocksRegional nerve blocks of the face and ear can be a wonderful choice of analgesia in a child, particularly for wounds that need to be repaired. The benefits include fewer local injections, improved cosmesis due to less wound margin distortion, and improved analgesia within the nerve region.1,2 The following blog post and brief video tutorial review the key elements of this technique.

Facial Nerve Blocks: Technique

We recommend lidocaine 1% or bupivicaine 0.25% with a 24-47 gauge needle. Prior to the injection, application of topical lidocaine to the area can provide additional benefit and reduction of injection discomfort. Only 1-2 mL of anesthetic are required for efficacy.

Usual injection technique should be applied for these regional nerve blocks including cleaning the skin prior to skin puncture and correct needle placement verification with aspiration prior to injection. After injection, allow 5-10 minutes for medication to reach efficacy.

Regional Facial Nerve Block: Overview and Technique

Drawings by Dr. Anisha Malhotra

  1. Supraorbital (V1)
  2. Infraorbital (V2)
  3. Mental (V3)
  4. Auricular (Auriculotemporal and greater auricular nerves)

 

1.
Salam G. Regional anesthesia for office procedures: part I. Head and neck surgeries. Am Fam Physician. 2004;69(3):585-590. [PubMed]
2.
Moskovitz J, Sabatino F. Regional nerve blocks of the face. Emerg Med Clin North Am. 2013;31(2):517-527. [PubMed]
Ashley Foster, MD

Ashley Foster, MD

PEM Fellow
Boston Children's Hospital
Delphine Huang, MD

Delphine Huang, MD

Resident
Department of Emegency Medicine (EM) UCSF-San Francisco General Hospital EM Residency Program
Aaron Kornblith, MD

Aaron Kornblith, MD

Assistant Clinical Professor
Department of Emergency Medicine & Pediatrics
University of California, San Francisco