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Anesth Analg 2006;103:1052
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000239085.08303.38

LETTER TO THE EDITOR

Editor-in-Chief Steven L. Shafer

Blink Reflex for Trigeminal Nerve Block or Blind Local Anesthetic Infiltration

Xavier de Lacroix de Lavalette, MD

Department of Anesthesiology; Clinique de la Baie; Villedieu, France; xdldl{at}wanadoo.fr

To the Editor:

Bernard and Péréon (1) used the blink reflex to identify the infraorbital branch of the trigeminal nerve to provide regional anesthesia for elderly patients undergoing minor surgery of the nose, cheek, or lower eyelid. The infraorbital branch is a strictly sensory nerve, and only results in a motor response through its bulbar connection between trigeminal and facial nerves.

Blind infiltration of local anesthetic solution around the cutaneous emergence of infraorbital nerve would lead to the same surgical comfort. Superficial face surgery is usually made after skin infiltration with local anesthetics, and I am not convinced of a major difference with infraorbital block (2).

Physiologically, the authors do not bring additional evidence to support their notion that the blink reflex is the neurophysiologic motor response to that stimulation, such as that used by laboratories as a diagnostic tool for bulbar or trigeminal pathologies. Laboratory studies show that blink reflex response is bilateral (3). Using the technique of Bernard and Péréon, I noticed clear homolateral blink reflex. Could other mechanisms explain such a difference?

REFERENCES

  1. Bernard JM, Péréon Y. Nerve stimulation for regional anesthesia of the face: use of the blink reflex to confirm the localization of the trigeminal nerve. Anesth Analg 2005;101:589–91.[Abstract/Free Full Text]
  2. Eaton JS, Grekin RC. Regional anesthesia of the face. Dermatol Surg 2001;27:1006–9.[ISI][Medline]
  3. Aramideh M, Ongerboer de Visser BW. Brainstem reflexes: electrodiagnostic techniques, physiology, normative data, and clinical applications. Muscle Nerve 2002; 26:14–30.[ISI][Medline]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press