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Regional Anesthesia In Otolaryngology

University of Texas Medical Branch Dept. of Otolaryngology Jacques Peltier MD Francis Quinn MD May 24, 2006
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Advantages of Local Anesthesia


The patient is conscious during surgery. Smooth postoperative course. Patient awake and maintains his own airway. Less pain needs less narcotics, lighter
anesthesia in general cases. Less nursing care after procedures, less admissions. Less expensive

Disadvantages of Local Anesthesia


The patient may prefer to be asleep Specialized skill necessary. Some blocks require up to 30 minutes to

be fully effective. Analgesia may not always be totally effective, and general anesthesia may be required anyway.
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Disadvantages of Local Anesthesia


Generalized toxicity may occur if local
anesthetic drugs are given intravenously by mistake or an overdose is given. Widespread sympathetic blockade can result in hypotension. There is a small but definite incidence of prolonged nerve damage.
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Local Anesthetics

Agent: Lidocaine with epi (1 or 2%) Lidocaine without epi Mepivacaine without epi (3%) Bupivacaine with epi (0.5%) Articaine with epi (4.0%) Dose: 7mg/kg 4.5mg/kg 5.5mg/kg 1.3mg/kg 7mg/kg Onset/Duration: Fast/medium Fast/short Fast/short Long/long Fast/medium

*ADULT DOSES IN PATIENTS WITHOUT CARDIAC HISTORY

Scalp Blocks

Scalp Blocks

Scalp Blocks

Scalp Blocks

Scalp Blocks

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Trigeminal Nerve Blocks

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Gasserian Ganglion Block

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Mandibular Nerve Blocks

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Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

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Inferior Alveolar Nerve Block

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Mental Nerve Block

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Mental Nerve Block

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Mental Nerve Block

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Maxillary Nerve Blocks

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Maxillary Nerve Blocks

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Maxillary Nerve Blocks

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Maxillary Nerve Blocks

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Maxillary Nerve Blocks

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Maxillary Nerve Blocks

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Local Blocks

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Supraorbital Nerve Blocks

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Supratrochlear Nerve Blocks

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Infraorbital Nerve Blocks

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Nasociliary and Anterior Ethmoidal Nerve Blocks

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Local Blocks for Nasal Surgery

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Maxillary Nerve Blocks

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Local Blocks for Nasal Surgery

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Local Ear Blocks

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Local Ear Blocks

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Local Ear Blocks

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Local Ear Blocks

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Local Ear Blocks

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Cervical Blocks

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Cervical Blocks

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Cervical Blocks

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Cervical Blocks

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Cervical Blocks

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Cervical Blocks

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Cervical Blocks

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Spinal Accessory Nerve Block

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Glossopharyngeal Nerve Block

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Glossopharyngeal Nerve Block

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Glossopharyngeal Nerve Block

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Glossopharyngeal Nerve Block

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Airway and Laryngeal Blocks

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Laryngeal Anesthesia

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Special thanks to Melinda Quinn for help in scanning slides used in this presentation.

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References
Atlas of Regional Anesthesia, Katz et. al, Multiple pages,
Appleton and Lange 1994 Techniques of Regional Anaesthesia, Scott et. al, Appleton and Lange, 1989 Regional Anesthesia of the oral cavity, Jastak and yagiela, The Mosby Company 1981 Illustrated Handbook in Local Anaesthesia, Eriksson, W.B. Saunders Company 1979

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