Distal Trigeminal Block

Published on 06/02/2015 by admin

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Last modified 22/04/2025

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23 Distal Trigeminal Block

Perspective

This block can be used for the diagnosis of facial neuralgia; however, more frequently it is used for superficial surgical procedures that require more than simple infiltration for anesthesia.

Patient Selection

Almost all patients are candidates for distal trigeminal blocks because the bony foramina—supraorbital, infraorbital, and mental—are easily palpable.

Pharmacologic Choice

Owing to the small volumes of local anesthetic necessary for this block, almost any local anesthetic agent may be chosen.

Placement

Anatomy

The distal branches of the three divisions of the trigeminal nerve—ophthalmic (supraorbital), maxillary (infraorbital), and mandibular (mental)—exit from the skull through their respective foramina on a line that runs almost vertically through the pupil (Fig. 23-1).

Figure 23-1. Distal trigeminal nerve: anatomy.

Position

The patient is placed in the supine position with the anesthesiologist at the patient’s side, approximately at the level of the shoulder.

Needle Puncture

For this block, as illustrated in Figure 23-2, once the respective foramina are identified by palpation, a short, 25-gauge needle is inserted in a cephalomedial direction near each foramen, and approximately 2 to 3 mL of local anesthetic is injected at each site. If a paresthesia is obtained, the local anesthetic can be deposited at that point.

Figure 23-2. Distal trigeminal nerve block: technique.

Potential Problems

This block is superficial and thus carries with it few complications. One should be cautious about entering the foramina to inject the local anesthetic because intraneural injection is probably more frequent with that approach.

Pearls

The anesthesiologist should ensure that the patient is properly sedated and should clearly identify the foramina to be blocked, so that accurate needle placement is achieved.

Related

Atlas of Regional Anesthesia 4e