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A regional nerve block is a targeted method for providing analgesia and is performed by injecting local anesthetic medication near specific nerves that control sensory innervation to a specific region of the body. Regional nerve blocks offer several advantages over local tissue infiltration. For instance, they are beneficial when local infiltration could cause tissue damage or distortion, particularly in delicate areas such as the face. Additionally, nerve blocks usually require a lower volume of anesthetic compared to local infiltration to achieve effective analgesia. The infraorbital nerve block is particularly effective for procedures involving the skin between the lower eyelid and upper lip, as well as for dental procedures on the maxillary teeth on the same side. This procedure can be performed using either an extraoral or intraoral approach, with the more commonly used intraoral method. The infraorbital nerve block technique specifically targets the branches of the maxillary nerve that innervate the midface. Indications for this block include wound closure, dental procedures, trigeminal neuralgia, and other midface procedures in patients contraindicated for general anesthesia. Care must be taken to avoid intravascular injection during the procedure. This activity outlines the indications, contraindications, and methodology for performing an infraorbital nerve block, emphasizing its practical application and effective use in various clinical settings. This activity emphasizes the importance of an interprofessional healthcare team in monitoring patients during an infraorbital nerve block, ensuring both patient safety and effective analgesia throughout the procedure. Objectives: Identify the anatomical landmarks for performing an infraorbital nerve block, including the infraorbital foramen and surrounding structures. Implement the appropriate infraorbital nerve block technique (extraoral or intraoral approach) based on the clinical scenario and patient anatomy. Select the appropriate anesthetic agent and dosage for the infraorbital nerve block, considering factors such as onset time, duration, and patient-specific factors. Collaborate with the interprofessional healthcare team to ensure comprehensive patient monitoring and management of the condition during the procedure. Access free multiple choice questions on this topic.

Nerve blocks are effective for providing analgesia in a localized area of the body and offer several advantages over local tissue infiltration. A key benefit of nerve blocks is that they generally require a lower volume of anesthetic to achieve effective analgesia compared to local infiltration, thus reducing distortion of surrounding tissues, which is important in areas such as the face. IIndications for an infraorbital nerve block include wound closure, dental procedures, trigeminal neuralgia, and various procedures on the midface, especially in patients who have a contraindication to general anesthesia.[1] However, nerve blocks are less effective when a wound extends across an area innervated by several nerves. The infraorbital nerve, a terminal branch of the maxillary nerve, provides sensory innervation to the lower eyelid, the side of the nose, the upper lip, the upper incisors, the canines, the premolars, and the root of the first molar.[2] An infraorbital nerve block is particularly useful for procedures involving the skin between the inferior palpebral and superior labial regions, as well as dental procedures on the ipsilateral maxillary teeth. The infraorbital nerve block is easily performed by infiltrating anesthetic medication at the point where the infraorbital nerve exits the infraorbital foramen of the maxilla bone. This can be performed using either an extraoral or intraoral approach, with the latter method being more common. The intraoral approach involves injecting the anesthetic into the buccal mucosa opposite the upper second bicuspid tooth, approximately 0.5 cm from the buccal surface in adults. The extraoral approach involves injecting the medication into the tissues surrounding the infraorbital foramen.[3] Care must be taken to avoid intravascular injection.

Complications from an infraorbital nerve block may include bleeding, hematoma formation, infection, injury to the artery or vein, unintentional injection of anesthetic into the artery or vein, nerve damage, or edema.[14][15] In the event of intravascular injection with a local anesthetic, 20% intravenous fat emulsion should be administered if available, starting with a 1.5-mL/kg bolus over 2 to 3 min, followed by an infusion at 0.25 mL/kg/min.[16] Special considerations include avoiding injection into the infraorbital foramen, as this could lead to long-term neuropathy due to nerve compression, damage to the orbital floor, or injury to the orbit. If there is any suspicion of orbital damage, immediate consultation with ophthalmology is required. Allergic reactions to the anesthetic medication can occur during the procedure, and management should be supportive based on the affected organ systems. Other possible reactions to anesthetic medications may include cardiovascular and neurological symptoms. In addition, methemoglobinemia is also a possible complication, depending on the anesthetic agent used.

The successful administration of an infraorbital nerve block depends on the collaborative efforts of an interprofessional healthcare team. Specialists such as anesthesiologists, dentists, trauma surgeons, facial surgeons, and emergency department physicians may perform the nerve block. A dedicated nurse should be assigned to monitor the patient throughout the procedure. Additionally, resuscitation equipment must be readily available in the operating room before starting the procedure to manage any potential complications, such as intravascular injection. Although the procedure is relatively straightforward and safe, inadvertent injury to the nerve is a recognized risk. Additionally, due to the proximity of the infraorbital artery and vein, a risk of intravascular injection exists. This issue can be managed by 20% intravenous fat emulsion, which should be readily available, and its location should be confirmed as part of the pre-procedure checklist. After the procedure, the patient must be monitored for 30 to 45 minutes to ensure no complications arise. Collaboration among interprofessional healthcare providers enhances the precision and safety of the procedure, contributing to optimal patient outcomes and a higher standard of care.

The below-mentioned key interventions should be followed to ensure a successful and safe infraorbital nerve block procedure. Informed consent should be obtained from the patient. The patient should be educated about the procedure, including its potential risks and benefits. The skin site must be thoroughly cleaned before injection. The instrument tray should be prepared with all necessary equipment. Monitoring and resuscitation equipment must be confirmed as available and functional in the procedure room.

Effective monitoring is essential for patient safety during and after an infraorbital nerve block. Therefore, the healthcare team should follow the steps below. Continuously monitor the patient’s vital signs throughout and after the procedure. Observe for any signs of bleeding, anxiety, or pain at the injection site. Watch for signs of allergic reactions or other adverse effects related to the anesthetic agent.