Infraorbital Nerve Block

An infraorbital nerve block will anesthetize the skin of the face from the lower eyelid down to the upper lip. It’s a great block for any painful procedure of this region, which is commonly a laceration repair. This is especially helpful if repairing the vermillion border, as a local injection may cause tissue swelling which can distort the anatomy leading to an inferior cosmetic outcome.

The infraorbital foramen is on the infraorbital rim in a vertical line with the pupil if looking straight forward.

You can inject here through the skin, but the intraoral approach is preferred.

Before an intraoral injection, I recommend applying topical lidocaine to the site, which can be done with viscous lidocaine on a 2x2 gauze, or with a commercially available lidocaine product, leaving it in place for a couple of minutes.

Using a 25-27 gauge 1.5-inch needle, insert it through the mucosa of the second premolar (that’s the 5th tooth over). Aim towards the foramen, which is usually about 2 cm from the mucosa, aspirate, and inject 2-3 ml of local anesthetic. If you’re very careful not to poke yourself, you can place a finger over the foramen to feel the anesthetic infiltrate and prevent it from going into the lower eyelid with some gentle pressure.

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