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LETTER TO THE EDITOR

Emergent Facial Lacerations Repair in Children: Nerve Blocks to the Rescue!

Department of Anesthesiology; Rush Medical Center; Chicago, IL; stefan_budac{at}rush.edu (Budac) Departments of Anesthesiology & Pediatrics; Children’s Memorial Hospital; Feinberg School of Medicine, Northwestern University; Chicago, IL; ssuresh{at}northwestern.edu (Suresh)

To the Editor:

Infraorbital nerve block can provide postoperative analgesia for procedures involving the upper lip and vermilion (e.g., cleft lip repair) (1) and nasal surgery (e.g., septal reconstruction, rhinoplasty, and endoscopic sinus surgery) (2). We performed this block on a 2-yr-old girl who presented with severe facial laceration involving the philtrum and the maxillary area (Fig. 1). After informed consent was obtained from her parents and induction of general anesthesia, infraorbital nerve blocks were performed using an intraoral approach. The infraorbital foramen was palpated, the upper lid was everted, and a 27-gauge needle was advanced using a subsulcal approach towards the infraorbital foramen. One mL of 0.25% bupivacaine with 1:200,000 epinephrine was injected after aspiration on each side. Postoperatively she was pain-free and required no rescue pain medication for more than 48 hours. On follow-up for suture removal the parents reported complete satisfaction with the postoperative course.

View larger version (148K): [in this window] [in a new window]   Figure 1. Block for severe facial laceration involving the philtrum and the maxillary area.

Infraorbital nerve block is an excellent option for postoperative pain control for facial trauma involving the upper lip and inframaxillary area. Bilateral injections can provide excellent pain relief without the side effects of systemic opioids.

References

1. Bosenberg AT, Kimble FW. Infraorbital nerve block in neonates for cleft lip repair: anatomical study and clinical application. Br J Anaesth 1995;74:506–8.[Abstract/Free Full Text]
2. Molliex S, Navez M, Baylot D, et al. Regional anesthesia for outpatient nasal surgery. Br J Anaesth 1996;76:151–3.[Abstract/Free Full Text]

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