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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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The distal branches of the three divisions of the trigeminal nerve—ophthalmic (supraorbital), maxillary (infraorbital), mandibular (mental)—exit from the skull through their respective foramina on a line that runs almost vertically through the pupil ( Fig. 23-1 ).

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Figure 23-1  Distal trigeminal nerve: anatomy.


The patient is placed in the supine position with the anesthesiologist at the patient’s side, approximately at the level of the shoulder.

Needle Puncture.

For this block, as illustrated in Figure 23-2 , once the respective foramina are identified by palpation, a short, 25-gauge needle is inserted in a cephalomedial direction, and approximately 2 to 3 mL of local anesthetic is injected at the site. If a paresthesia is obtained, the local anesthetic can be deposited at that point.

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Figure 23-2  Distal trigeminal nerve block: technique.

Potential Problems.

The distal trigeminal block is superficial and thus is associated with few complications. One should be cautious about entering the foramina to inject the local anesthetic because intraneural injection is probably more frequent with that approach.

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