How To Do an Auricular Block

Because there is minimal subcutaneous tissue on the pinna, direct injection of local anesthetic to anesthetize the pinna can be difficult and uncomfortable. Auricular block may be used for

• Repair of laceration of the pinna

• Drainage of an auricular hematoma

Absolute contraindications

• History of allergy to the anesthetic agent or delivery vehicle (choose a different anesthetic)

Relative contraindications

• Infection in the path of needle insertion: Use procedural sedation or other anesthesia.

• Adverse reaction to the anesthetic or delivery vehicle (eg, allergic reaction to the anesthetic [rare] or to methylparaben [a preservative])

• Rarely, toxicity due to anesthetic overdose (eg, seizure, cardiac arrhythmias)

• Hematoma

• Nonsterile gloves, mask, and safety glasses or a face shield

• 5- to 10-mL syringe, 25- or 27-gauge needle: 3-cm long for injection 

• Consider sedation or an alternative method of anesthesia for patients unable to cooperate with procedure.

The auricle is innervated by 3 nerves:

• Greater auricular nerve

• Lesser occipital nerve

• Auriculotemporal nerve

The relevant anatomic landmarks of the ear are the helical root, concha, lobule.

• Supine with the head supported on a pillow and rotated so the affected ear is upward

See also figure Auricular Block.

• Apply nonsterile gloves, mask, and safety glasses or a face shield.

• Cleanse ear and surrounding skin with antiseptic solution and allow to dry.

• There are 2 needle insertion sites: one approximately 2 cm inferior to the lobe of the ear (see 1 on figure Auricular Block) and the other approximately 1 cm superior to the pinna (see 2 on figure).

• Inject a small amount of anesthetic at the injection site inferior to the lobe (see 1 on figure Auricular Block) to form a skin wheal. Direct the needle toward a point 1cm anterior to the tragus (see A on figure) and inject 2 mL of anesthetic as the needle is withdrawn. Do not completely remove the needle from the subcutaneous space.

• Redirect the needle toward the mastoid process (see B on figure Auricular Block) and inject 2 mL of anesthetic as the needle is withdrawn.

• Inject a small amount of anesthetic superior to the pinna (see 2 on figure Auricular Block) to form a skin wheal. Direct the needle toward a point 1cm anterior to the tragus (see C on figure) and inject 2 mL of anesthetic as the needle is withdrawn. Do not completely remove the needle from the subcutaneous space.

• Redirect the needle toward the mastoid process (see D on figure Auricular Block) and inject 2 mL of anesthetic as the needle is withdrawn.

• Await onset of anesthesia (3 to 5 minutes).

Auricular Block

• Ensure hemostasis at the injection site.

• Instruct patient regarding anticipated time to anesthesia resolution.

• Additional care based on the procedure performed after nerve block was completed.

• Distraction techniques (eg, talking to the patient or having the patient hold someone else's hand) may help to reduce patient anxiety.

• Inject the local anesthetic solution slowly (30 to 60 seconds) to reduce the pain of injection.