II. Indication

  1. Regional Anesthesia for forehead

III. Physiology: Landmarks (V1-ophthalmic branch nerves)

  1. Supraorbital Nerve
    1. Exits skull at supraorbital foramen, along the orbital ridge
    2. Upper orbit border, between upper lid and brow
    3. Centered over upper lid (~2.5 cm lateral to midline) and directly above the pupil on forward gaze
  2. Supratrochlear Nerve
    1. Exits skull 1 cm medial to supraorbital foramen

IV. Technique: Supraorbital and Supratrochlear Nerve Block

  1. Images
    1. SurgeryBlockForehead.jpg
  2. Locate supraorbital foramen as above
  3. Insert needle
    1. Lateral to supraorbital foramen
    2. Direct needle medially, parallel to brow, toward nose
  4. Infiltrate mid-two thirds of lower edge of eyebrow
    1. Use 5-7 cc of 1% Lidocaine
    2. Inject just above bone level
    3. Redirect needle if Paresthesias or sharp pain

V. Complications

  1. Eyelid Swelling
  2. Hematoma
  3. Periorbital Ecchymosis

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