Local Anesthetics in the face

Joseph Amado C. Galvez M.D. FPSOHNS

Peripheral nerve blocks
Minor
 Blocks of individual nerves
Radial nerve block

Major
 Blocks of two or more nerves, or a plexus of nerves
Brachial plexus block
Peripheral nerve blocks
The drug is usually selected based on the duration of
anesthesia that is required

The duration of action of minor nerve block is

prolonged by the addition of epinephrine to the local
anesthetic solution
Infiltration of Local Anesthetics
Agent is injected into the operative site without
selectively blocking a specific nerve
May be:
 Intradermal
 Subcutaneous
 Both
Infiltration of Local Anesthetics
The duration of action will vary

The addition of epinephrine will prolong the duration

of analgesia

Dilute anesthetic solutions are recommended for large

areas to avoid toxicity
Infiltration of Local Anesthetics
Infiltration of local anesthetic causes a painful,
burning sensation

Injection into the dermis is the most painful and

provides the fastest onset of action

Addition of sodium bicarbonate decreases the pain

associated with infiltration
Toxicity of Local Anesthetics
To avoid toxicity, local anesthetics must be
administered within a safe dose range and in the
correct anatomic location

During local anesthesia, when toxic reaction occurs,

they are almost always the result of inadvertent
intravascular injection or the administration of an
excessively large dose
Toxicity of Local Anesthetics
Every efforts should be made to avoid intravascular
injection

The syringe should always be aspirated before the local

anesthetic is injected regardless of the anatomic site of
injection

An intravascular injection of an epinephrine

containing solution may produce a dangerously
hypertensive response
Toxicity of Local Anesthetics
The addition of epinephrine to the anesthetic solution
delays absorption and results in lower anesthetic
blood levels, as well as a longer duration of the action

Epinephrine is especially useful when local anesthetic

is being injected into highly vascular areas such as the
face
Anatomy of the fifth cranial nerve ganglion
(trigeminal) along with innervation and
peripterygoid relationship
Anatomy and needle-insertion plane of trigeminal ganglion block
technique. See text for details and correlate with Picture 14