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Greater auricular block - never thought you could block such a tiny little nerve with ultrasound.

ear before after.jpg

We blocked this ear with a single injection allowing comfortable irrigation and repair using an ultrasound-guided greater auricular block.

Ultrasound-guided greater auricular block works well for the outer rim (helix) of the ear and the ear lobe itself.  It will not anesthetize the inner concha or the most superior part of the ear.  No luck for auricular hematomas:( 

 

Anatomy gtr auricular.jpg

The greater auricular nerve exits around the posterolateral border of the SCM at (1) and runs on top of the SCM to innervate the inferior portion of the ear (shaded).  (3) SCM insertion on the clavicle (4) Sternal notch (5) superior pole of the thyroid cartilage

 

The key to locating the nerve from the "noise" in the shallow subcutaneous area over the SCM is to trace it lengthways as it courses superiorly and medial over the SCM from its exit at the C6 level to the ear.  

The key to locating the nerve from the "noise" in the shallow subcutaneous area over the SCM is to trace it lengthways as it courses superiorly and medial over the SCM from its exit at the C6 level to the ear.

 

(1) Area blocked with the greater auricular nerve block = lobule and tail of the helix. Other areas are less consistently blocked: (2) spine of helix, (3) concha, (4) Antihelix, (5) anti-tragus, (6) tragus.

(1) Area blocked with the greater auricular nerve block = lobule and tail of the helix. Other areas are less consistently blocked: (2) spine of helix, (3) concha, (4) Antihelix, (5) anti-tragus, (6) tragus.

setup for block.jpg

Here is the set up.  The patient can roll on their side as seen above or be seated upright.  I like the posterior approach, but could be done anteriorly as well.  The nerve is a tiny hypoechoic structure that you find by sliding up and down the border of the SCM watching for the nerve to curl under the lateral border to join with the superficial cervical plexus between the SCM and  the levator scapulae at the level of the thyroid cartilage.

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This is another case where we used a selective greater auricular block for an ear abscess

 

ear abscess copy.jpg
ear pus.jpg
ear loop.jpg

The superficial cervical plexus block was developed for emergency use at Highland and we use it routinely for ear, neck, clavicle injuries, as well as placing lines--IJ, pocket shots, sub-clavian lines. Go more in depth with our workbook and use below for a quick reference.

Beautiful Nagdev How to!

Scp Block How To