What are steps to perform the ring block technique for ear anesthesia?

Updated: Jun 14, 2018
  • Author: Daniel J Hutchens, MD, MS; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Answer

Answer

Steps for this technique are as follows:

  • Disinfect skin with an alcohol swab.

  • Insert the needle into the skin just inferior to the attachment of the earlobe to the head. Do not insert the needle into the earlobe itself. Advance the needle just anterior to the tragus, aspirating as the needle advances.

  • Aspirate and then inject 2-3 mL of anesthetic while withdrawing the needle slowly back toward the puncture site without removing it.

  • Once just under the skin at the puncture site, redirect and advance the needle posteriorly along the inferior posterior auricular sulcus, aspirating as it is advanced.

  • Aspirate and inject 2-3 mL of anesthetic while withdrawing the needle.

  • Remove the needle and reinsert it just superior to the attachment of the helix to the scalp. Direct and advance the needle just anterior to the tragus, aspirating as it is advanced.

  • Aspirate and inject 2-3 mL of anesthetic while withdrawing the needle toward your puncture site without removing it. Remember to inject the subcutaneous tissue, not the ear cartilage.

  • Once just under the skin at your puncture site, redirect and advance the needle posteriorly along the superior posterior auricular sulcus, aspirating as it is advanced.

  • Aspirate and inject 2-3 mL of anesthetic while withdrawing the needle.

  • Be aware that the superficial temporal artery, located medial to the ear, crosses over the zygomatic arch. If the artery is cannulated, maintain firm pressure with gauze for at least 20-30 minutes.


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