title: Regional nerve blockade prior to direct injection to achieve anaesthesia of the nasal ala.
abstract: BACKGROUND
  Dermatological surgical procedures involving the nasal alae are commonplace in clinical practice. Direct infiltration of local anaesthetic into the nasal ala is extremely uncomfortable.
  
  
  OBJECTIVE
  In this prospective clinical study, we investigate the effectiveness of alar anaesthesia provided by an infraorbital nerve block (IOB).
  
  
  METHODS
  We recruited 100 consecutive patients requiring dermatological surgical procedures involving the nasal ala (or other sites necessitating an IOB). Following topical mucosal anaesthesia, an IOB was administered via the intraoral route. Effectiveness of anaesthesia was assessed after 10 min by testing the perception of a sharp stimulus at five standardized reference points on the nasal ala. If the ala was not completely anaesthetized, blockade of the external nasal branch of the anterior ethmoidal nerve (external nerve block, ENB) was performed. Sensation of the nasal ala was re-assessed after 10 min using the above method.
  
  
  RESULTS
  Complete anaesthesia of the nasal ala was achieved with an IOB in 66 of 100 (66%) patients. Of the remaining 34 patients, the addition of an ENB achieved complete anaesthesia in 15 (44%).
  
  
  CONCLUSIONS
  An IOB provides effective alar anaesthesia in the majority of patients. In those where it is ineffective for complete anaesthesia, an ENB is a useful adjunct. We recommend using an IOB (and ENB if required) prior to direct infiltration of local anaesthetic into the nasal ala to reduce patient discomfort.
authors.affiliation: Dermatologic Surgery Unit, Skin Cancer Institute, 171 Cameron Road, Mount Maunganui, Tauranga, New Zealand. njmort2002@yahoo.co.uk
authors.forename: N J
authors.initials: NJ
authors.lastname: Mortimer
authors.forename: W
authors.initials: W
authors.lastname: Hussain
authors.forename: M J
authors.initials: MJ
authors.lastname: Sladden
authors.forename: P J
authors.initials: PJ
authors.lastname: Salmon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000601:surgery*; D009407:Nerve Block / Q000379:methods*; D009666:Nose / Q000601:surgery*; D009668:Nose Diseases / Q000601:surgery*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D055815:Young Adult