Regional anesthesia is commonly used for postoperative pain management to decrease postoperative pain and opioid consumption following head and neck surgery. Myriad techniques can be used for both acute and chronic pain management either diagnostic or therapeutic procedures. Because of the vicinity of cranial and cervical nerves to many vital structures in a compact area, the efficacy and safety of cephalic blocks are based on precise and detailed knowledge of the anatomical relationships of the selected nerve, its deep and superficial courses, and the final sensory territories.
Sensory innervation of the face and neck is supplied by the trigeminal nerve (fifth cranial or V) and the C2–C4 cervical nerve roots that constitute the superficial cervical plexus. This chapter outlines clinically applicable regional blocks of the face that for perioperative and chronic pain management.
For each block, practical anatomy, indications, technique, and type of complications are specifically described.
Infiltration or instillation of local anesthetics around and into the joint as an analgesic adjunct for postoperative joint surgery pain has been used for decades. However, there has been a renewed interest in local infiltration analgesia (LIA), partly due to the work in 2008 of Kerr and Kohan,(1) who demonstrated superior analgesia after total knee or hip arthroplasty with extended, diluted infiltration of local anesthesia with epinephrine and ketorolac added and repeated injections through intraarticular catheters. The interest in using LIA in knee and hip surgery may be also due to the lack of the simpler regional anesthesia alternatives that exist for other joints. For instance, analgesia after shoulder and upper extremity surgery can be accomplished with a simple, single injection block of the brachial plexus, whereas analgesia for hip and knee joints requires multiple and more technically challenging nerve blocks. Also, while motor weakness is common with nerve blocks, infiltration analgesia typically spares the motor function.