Supraorbital Nerve Injection

Supraorbital Nerve Injection
Indication	Headache disorders and laceration repair
Syringe	1-3mL
Needle	27-30G
Local	1-3mL of anaesthetic
Volume	1-3mL

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Anatomy

The supraorbital nerve is a branch of the terminal cutaneous branches of the frontal nerve. It runs through the supraorbital notch and innervates the upper eyelid, forehead, and anterior 1/3 of the scalp. It then ascends up the forehead. It is closely associated with the supraorbital artery medially. The supraorbital nerve is found just above the supraorbital notch.

Cranio-cervical Dermatomes.^[1]

Indications

Headache disorders
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

Obtain informed consent
Place patient in supine position or seated
Draw up 2-5cc of anesthetic into syringe
Palpate the supraorbital notch over the medial aspect of the supraorbital ridge
Prep area
Advance the needle towards foramen to a depth of 4-5mm
Aspirate, and if no blood, inject 1-3 cc of anesthetic slowly
Massage area for 10-15 seconds
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

References

↑ Blumenfeld et al.. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache 2013. 53:437-46. PMID: 23406160. DOI.

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

[1] Blumenfeld et al.. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches--a narrative review. Headache 2013. 53:437-46. PMID: 23406160. DOI.

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