Morning Report: 3/21/14

Dr. Shin presents today’s special March Madness edition of Morning Report!

Inferior Alveolar Nerve Block

A nerve block of the intraoral mandibular or inferior alveolar nerve anesthetizes the following:

• The body of the mandible and the lower portion of the ramus
• All mandibular teeth
• The floor of the mouth
• The anterior two thirds of the tongue
• Gingivae on the lingual surface of the mandible
• Gingivae on the labial surface of the mandible
• Mucosa and skin of the lower lip and chin

Equipment

• An overhead light of sufficient intensity should be present.
• Sterile thumb-control syringe
• Topical anesthetic (in the form of pastes or gels)
• 2% lidocaine with epinephrine or 0.5% bupivacaine with epinephrine
• Cotton-tipped applicators to administer topical anesthetic and control bleeding
• Small-gauge needles (The longer the needle, the easier the inferior alveolar nerve block is to accomplish.)
  • Approximately 1.5-2 inches

The technique is as follows, based on the description of Powell

• Apply topical anesthetic to the target area
• Place the thumb of the nondominant hand on the coronoid notch and the index finger just anterior to the ear to stretch the tissues over the injection site
• With the anterior ramus technique, palpate the anterior border of the ramus with the thumb and find the greatest concavity, which is the coronoid notch.
  
• Orient the syringe so that the barrel is in the opposite corner of the mouth, resting on the premolars.
• Aim toward the index finger and slowly penetrate the mucosa until bone is contacted.
  • If the attempt does not result in contact with bone, reorient the syringe more laterally and repeat attempt.
• Withdraw slightly and aspirate.
  • Rotate the bevel of the needle and re-aspirate; if no blood is returned, inject 1.5-2 mL of anesthetic.
  • If aspiration is positive, pull back about 5 mm and redirect slightly, then repeat attempt at aspiration.
• If the injection fails to result in adequate analgesia, it may safely be repeated 2 additional times

References:

Scheinfeld, NS. Inferior Alveolar Nerve Block. Emedicine http://emedicine.medscape.com/article/82622-overview#a15

Ok, nothing specific to basketball but still good stuff!

The following two tabs change content below.

• Bio
• Latest Posts

Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

• Save of the Month! December 2015 - December 23, 2015
• Morning Report: Unprovoked First Seizure in Adults - September 11, 2015
• Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015