Maxillary Nerve Block Periprocedural Care

Updated: Jul 05, 2016
  • Author: Anusha Cherian, MBBS, MD, DNB; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Periprocedural Care

Patient Education and Consent

Before a complete maxillary nerve block can be performed, informed consent must be obtained from the patient. The procedure and the likely complications must be explained. Maxillary nerve block is a relatively safe procedure, and complications are very rare. The most common complication is patient discomfort arising from numbness of a wide area of the face. Stressing to patients that this effect is transient and does not last beyond a few hours is important.

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Equipment

Materials used in the performance of a maxillary nerve block include the following:

  • 25-gauge long needle (32-36 mm)
  • 22-gauge needle
  • 2-mL and 5-mL syringes
  • Cotton swab
  • Mouth props
  • Retractors
  • Local anesthetic: Generally, up to 2 mL of the drug (lidocaine 1-2%, mepivacaine 3%, or bupivacaine 0.5%) is required for the block; an additional 2 mL may be needed for skin infiltration.
  • Sterile drapes

Standard monitoring modalities (eg, pulse oximetry, noninvasive blood pressure [NIBP] monitoring, and electrocardiography [ECG]) should be available. Basic resuscitative drugs and equipment should be on hand in case of cardiorespiratory collapse.

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Patient Preparation

The patient may be allowed to have a light breakfast or may be placed on nil per os (NPO) status, as warranted by the specific procedure to be performed after the block. Sedation can be accomplished with midazolam 3-5 mg or fentanyl 50-100 µg intravenously.

Patient positioning for maxillary nerve block varies, depending on the specific approach followed:

  • High tuberosity approach: The patient is supine with the chin tilted upward, and the operator stands on the same side as that to be blocked.
  • Greater palatine canal approach: The patient is supine with the chin tilted upward and the mouth open, and the operator stands on the same side as the side where the block is to be performed.
  • Coronoid approach: The patient is supine with the face turned to the contralateral side, and the operator stands on the same side as that to be blocked.
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