Supraorbital Nerve Injection

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


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]

Cranial dermatomes.png

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

  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.
  • 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