ULTRASOUND-GUIDED INFRAORBITAL NERVE BLOCK

ULTRASOUND-GUIDED
INFRAORBITAL NERVE BLOCK –
development of the technique and
retrospective analysis of 30 patients
Pavel Michalek,
Francis McAleavey,
William Donaldson,
Lukas Pokorny
Department of
Anaesthetics, Antrim
Area Hospital, Antrim,
United Kingdom
INFRAORBITAL NERVE - Anatomy
• 2nd division of trigeminal nerve
• Exits the skull via infraorbital foramen
• Innervates the lower eyelid, upper lip, part of the
vestible
• The block used for perioperative and postoperative
pain during ENT, dental, maxillofacial surgery, cleft lip
repairs, for wound closures, debridement, chronic
pain
• (Karkut, JADA 2010; Berberich, J Endod 2009; Takmaz, Ann
Plast Surg 2009; Mariano, Can J Anaesth 2009; Suresh, RAPM
2006 ; Higashizawa, J Anesth 2001)
INFRAORBITAL NERVE - Anatomy
INFRAORBITAL NERVE - Anatomy
INFRAORBITAL NERVE - Technique
INFRAORBITAL NERVE - Technique
PHASE 1 – DEVELOPMENT OF
TECHNIQUE ON THE SKULL MODEL
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2 adult skull models studied
10 infraorbital foramina in total examined
The skulls were immersed to the water bath
Scanning was done using a high-frequency (13-5 MHz)
linear probe (SonoSite M-Turbo)
• Two parameters were studied:
• 1) The possibility to locate the infraorbital foramen on
the skull model under US
• 2) Tracking the needle using IP technique (infraorbital
approach) in real-time US
PHASE 1 – DEVELOPMENT OF
TECHNIQUE ON THE SKULL MODEL
PHASE 1 – DEVELOPMENT OF
TECHNIQUE ON THE SKULL MODEL
Infraorbital
foramen
Orbital
space
Inferior
orbital rim
Maxilla
PHASE 1 – DEVELOPMENT OF
TECHNIQUE ON THE SKULL MODEL
Needle
Inferior
orbital wall
Infraorbital
foramen
PHASE 1 – DEVELOPMENT OF
TECHNIQUE ON THE SKULL MODEL
PHASE 2 – Audit of a pilot group
• Retrospective analysis of 30 patients who underwent
infraorbial nerve block under US using an intraoral
approach
• Indications – postoperative pain after ESS, oral
surgery, other ENT procedures
• Linear probe (13-5 MHz) (SonoSite M-Turbo) placed
between the canine tooth and the mid-point of the
eye.
• IP technique used.
• 2mL of 0.25% levobupivacaine (for each side)
PHASE 2
PHASE 2
RESULTS
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Location of the foramen – 100%
Location of the infraorbital artery – 77%
Location of the needle tip – 97%
Successful sensory block V/2 – 100%
VAS 0-2 in the first 24h – 83%
VAS 3-5 in the first 24h – 17%
None postoperative analgesics or paracetamol –
93%, i.v. boluses of morphine 7%
• No complications
LITERATURE SEARCH
CONCLUSIONS
• US using linear high-frequency
probe allows to locate
infraorbital foramen and
facilitate the needle placement
• US can help to avoid a
puncture/trauma of any vessel
(mainly infraorbital artery and
vein)
• The block success rate is high
and complication rate in the
first series of the patients low