Position and anatomical landmarks
Infiltration is carried out with the patient in the supine position with the head in a slightly backward flexion position. The head is positioned in the midline.
The upper margin of the orbita is located and the supra-orbital fissure palpated and marked. The distance between the infra-orbital foramen and median line is about 2.5 cm (see figure).
The surrounding area is disinfected and covered with sterile drapes. A needle (22-G, 5 cm, 1 cm active tip) is inserted perpendicularly (under ultrasound guidance) just medial to the supra-orbital fissure until there is contact with bone. The location of the nerve is confirmed when the patient experiences paresthesia in the forehead. The needle is withdrawn slightly and bupivacaine 0.25% with 20 mg of methylprednisolone is injected (in 2 ml).
- The most serious complication of the injection is infection.
- Small subcutaneous bleedings may result in a temporary increase in pain after the injection.