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The ear is a sensitive area.  You’ll want to anesthetize it well before any painful procedure. This includes laceration repair, incision and drainage, or treatment of auricular hematoma.

Direct local injection of a laceration on the ear itself can distend margins near the cartilage, making approximation all the more difficult.  Alternatively, one might consider a nerve block.  This works well for various regions of the face, such as the infraorbital nerve block for lacerations below the eye.  However, the ear is innervated by multiple cranial nerve branches and cervical nerve roots.  Thus, trying to block all of them is an exercise in futility.  Rather, field block–eg local anesthetic surrounding the ear to catch all of the small branches of the nerve supply–is the way to go.

I recommend the following technique shown in the two minute video above, and described in more detail below.

Achieving anesthesia of the sensitive ear is important prior prior to any painful procedure.
Achieving anesthesia of the sensitive ear is important prior prior to any painful procedure.
  • Use an alcohol prep to disinfect the skin.
  • Imagine drawing a diamond around the ear, with two apices above and below the ear, as pictured.
  • The procedure can be performed by piercing the skin just twice: once above the ear (1&2), and once below (3&4).  Injections are performed anterior and posterior to the ear with each skin penetration.
Points of needle entry for an auricular block. Note that in a well planned block, the skin is only pierced twice.
Points of needle entry for an auricular block. Note that in a well planned block, the skin is only pierced twice.
  • The first injection is performed at the meeting of the helix and the scalp, following the most superior portion of the helix.  Advance the needle anterior to the tragus, aspirating while advancing (per usual injection technique, to avoid blood vessel injection).
  • inject ~3 mL of the anesthetic while withdrawing the needle back toward your puncture site. However, don’t remove the needle!
  • When the needle is just under the skin at the original puncture site, redirect and advance it posterior to the ear.  Aspirate and inject another 3 mL of anesthetic while withdrawing the needle.  Now, remove the needle.
  • Insert the needle into the skin at the other apex of the diamond, just below the attachment of the earlobe.  Advance the needle just anterior to the tragus, aspirating as the needle advances.
  • Aspirate and then inject ~3 mL of anesthetic while withdrawing the needle slowly back toward the puncture site. Again, don’t remove it yet!
  • When the needle is just under the skin at the puncture site, redirect and advance it posterior to the ear.  Aspirate as you advance.  Inject ~3 mL of anesthetic while withdrawing the needle.
  • Pitfall: Remember that the superficial temporal artery, located medial to the ear, crosses over the zygomatic arch.  If the artery is accidentally pierced, facial hematoma can occur.  Maintain firm pressure for at least 30 minutes to avoid this complication.

Now, you are ready to begin your procedure!

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