0071643192.pdf

PROCEDURES AND SKILLS

CONTRAINDICATIONS

■ Infection overlying site of injection

TECHNIQUE

COMPLICATIONS

■ Placement of the needle or injection of liquid into the nerve or a foramen

can produce pain and neurovascular damage.

■ For the posterior-superior alveolar nerve block, puncture of the pterygoid

plexus and hematoma formation should the syringe not be aspirated

before injection. Also, if the needle were advanced too far posteriorly, a

Division II block of cranial nerve V will result.

■ For the inferior alveolar block–-injection of anesthetic posteriorly in the

region of the parotid gland, which will anesthetize the facial nerves, will

cause temporary facial paralysis (similar to a Bell palsy) that results in

inability to close the eyelid. Should this occur, the eye must be protected

until the local anesthetic has worn off (approximately 2–3 hours or up to

10–18 hours if marcaine is used).

INTERPRETATION OFRESULTS

■ Anesthesia of intended area signifies successful nerve block.

Procedural Sedation

INDICATIONS

■ To relieve the pain and anxiety associated with diagnostic and therapeutic

procedures performed in various settings

■ To allow the provider to perform procedures in uncooperative patients

■ To facilitate fracture and dislocation reductions by causing muscle relaxation

A B

FIGURE 19.10. Insertion site for needle during (A) infraorbital nerve block and (B) inferior alveolar nerve block.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Tintinalli’s Emergency Medicine: A Comprehensive

Study Guide, 6th ed. New York: McGraw-Hill, 2004:273.)