Supraorbital Nerve Injection

Background

• Supraorbital nerve innervates the ipsilateral upper eyelid, forehead, and anterior 1/3 of scalp
• Nerve block provides regional anesthesia without distortion of soft tissue seen in local infiltration

Indications

• Trauma or need to perform painful procedure on area innervated by supraorbital nerve

Contraindications

• Infection overlying injection site
• Previous allergic reaction to local anesthetic
• Uncooperative patient
• Distortion of anatomical landmarks

Equipment Needed

• local anesthesia
  • lidocaine 2% (lasts 30-60 minutes or longer if given with epinephrine, rapid onset of 4-6 minutes)
  • Bupivacaine 0.5% (lasts 2-4 hours, slowest in onset)
• 18 gauge needle to draw up anesthetic
• 1.5 inch 25 or 27 gauge needle
• 3-5cc syringe
• gauze pads
• gloves
• betadine/chlorhexidine

Procedure

1. Obtain informed consent
2. Place patient in supine position or seated
3. Draw up 2-5cc of anesthetic into syringe
4. Palpate the supraorbital foramen over the medial aspect of the supraorbital ridge
5. Prep area
6. Advance the needle towards foramen (5-10mm)
7. Aspirate, and if no blood, inject 1-3 cc of anesthetic slowly
8. Massage area for 10-15 seconds
9. If block is unsuccessful, inject a line of anesthetic solution along the orbital rim laterally to medially to block all branches of the ophthalmic nerve

Complications

• Bleeding/hematoma
• Infection
• Pain
• Swelling of face/eyelid
• Allergic reaction to anesthetic
• Damage to nerves/vessels

See Also

• Nerve blocks (main)

References

• Amsterdam J and Kilgore K. Regional Anesthesia of the Head and Neck. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014