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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
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