Infraorbital Nerve Block

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An infraorbital nerve block will anesthetize the skin of the face from the lower eyelid down to the upper lip. It’s a great block for any painful procedure of this region, which is commonly a laceration repair. This is especially helpful if repairing the vermillion border, as a local injection may cause tissue swelling which can distort the anatomy leading to an inferior cosmetic outcome.

The infraorbital foramen is on the infraorbital rim in a vertical line with the pupil if looking straight forward. 

You can inject here through the skin, but the intraoral approach is preferred.

Before an intraoral injection, I recommend applying topical lidocaine to the site, which can be done with viscous lidocaine on a 2x2 gauze, or with a commercially available lidocaine product, leaving it in place for a couple of minutes. 

Using a 25-27 gauge 1.5-inch needle, insert it through the mucosa of the second premolar (that’s the 5th tooth over). Aim towards the foramen, which is usually about 2 cm from the mucosa, aspirate, and inject 2-3 ml of local anesthetic. If you’re very careful not to poke yourself, you can place a finger over the foramen to feel the anesthetic infiltrate and prevent it from going into the lower eyelid with some gentle pressure.

Peer reviewed by Mel Herbert, MD and Scott Kobner, MD.

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