title: Ultrasound-guided Greater Auricular Nerve Block for Emergency Department Ear Laceration and Ear Abscess Drainage.
abstract: BACKGROUND
  Adequate emergency department (ED) anesthesia for painful ear conditions, such as ear lacerations or ear abscesses, can be challenging. Much of the sensory innervation of the ear is supplied from the anterior and posterior branches of the greater auricular nerve (GAN). The GAN is a branch of the superficial cervical plexus, which arises from the C2/C3 spinal roots. The GAN innervation includes most of the helix, antihelix, the lobule, and the skin over the mastoid process and parotid gland. Anesthesia of the GAN is commonly performed in emergency medicine as part of a landmark-based ear "ring" block. Recently, a selective ultrasound-guided GAN block has been described.
  
  
  METHODS
  We report the first cases of ultrasound-guided greater auricular nerve block (UGANB) successfully performed in the ED as the sole procedural anesthesia for both an ear laceration and abscess drainage. In addition, we review the relevant anatomy and technical details of the procedure. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our cases suggest that UGANB is a potentially effective nerve block for ED management of acute ear pain related to procedures involving the tail of the helix and the lobule, such as ear lacerations or ear abscess incision and drainage. Advantages include real-time visualization of the GAN that may increase block success and the decreased volume of local anesthetic required for a block.
authors.affiliation: Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California.
authors.forename: Stefan
authors.initials: S
authors.lastname: Flores
authors.affiliation: Department of Emergency Medicine, Highland Hospital-Alameda Health System, Oakland, California; Department of Emergency Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Herring
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D004322:Drainage; D004431:Ear, External / Q000293:injuries* / Q000294:innervation*; D004636:Emergency Service, Hospital; D006801:Humans; D022125:Lacerations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: acute pain; analgesia; ear abscess; ear laceration; emergency medicine; nerve block