0071643192.pdf

PROCEDURES AND SKILLS

TABLE 19.1. Regional Nerve Blocks

TECHNIQUE INJECTIONLOCATION/ANATOMY TISSUES AND/ORTEETHAFFECTED COMMENTS

Supraperiosteal injection Anesthetic will diffuse across Any maxillary tooth Straightforward, highly

(local infiltration) the bone to reach the nerve successful; ideal for relief

root of the involved tooth. of a toothache

Mental nerve block Inside the mouth, adjacent Buccal soft tissues from second Technically simple, highly

to the foramen below the mandibular premolar to midline; successful; ideal for repairing

second premolar skin of lower lip and chin lower-lip lacerations

Infraorbital (anterior Inside the mouth, opposite Maxillary teeth and buccal soft Highly safe and successful;

superior alveolar) nerve the upper second bicuspid tissues from midline through ideal for repairing lacerations

block and directed toward the canine; upper lip, lateral aspect to upper lip

foramen, a depth of of nose, and lower eyelid;

approximately 2.5 cm on maxillary premolars

inferior border of infraorbital

ridge

Posterior superior Distal to the distal buccal Entire second and third Highly effective but carries

alveolar nerve block root of the upper second maxillary molars significant risk of hematoma,

molar toward maxillary so frequent aspiration

tuberosity at depth of during injection is crucial

2 – 2.5 cm

Inferior alveolar nerve In the pterygomandibular All mandibular teeth to midline; Failure rate 15–20% even in

block triangle, at a point that is anterior 2/3 of tongue and floor experienced hands; extremely

1 cm above the occlusal of oral cavity; distribution of useful and, when successful,

surface of the molars mental nerve extremely effective

Ophthalmic (V 1 ) nerve Near the supraorbital notch, The forehead and the scalp back Suturing or debridement

block above a midline pupil, along to the lamboid suture of the forehead, scalp, or

the superior orbital rim delicate upper eyelid

Median nerve block On the radial border of the The anterior palm, the anterior Suturing or debridement

palmaris longus tendon just thumb, index finger, and middle of the hand and/or palm

proximal to the proximal finger

wrist crease

Ulnar nerve block On the ulnar aspect of the Fourth and fifth digits Suturing or debridement

wrist at the proximal palmar of the fourth and fifth digits

crease and is directed

horizontally under the flexor

carpi ulnaris

Digital nerve blocks Can be administered in the Any digit Epinephrine should not

finger, in the web space be used since it vasoconstricts

between the fingers, or digital blood supply.

between the metacarpals

on both sides of the bone