Glossopharygeal nerve block technique question...

[pastafan]

I have done these multiple times over the years for awake intubations. Most often patient was quite ill in ICU or OR. They were on the dry side and had a little sedation on board. Tried to do a diagnostic block to R/O glossopharyngeal neuralgia due to Eagle syndrome on fully awake patient in an office setting; first failure and I am discouraged.. Despite topical lidocaine and a very compliant patient, I could not get to the base of the tongue easily and the block was not effective.

Any suggestions besides turfing to surgery center, sedation, etc?

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[deleted171991]

Base of the tongue? Do you mean the posterior tonsillar pillar?

https://www.nysora.com/regional-and-topical-anesthesia-for-awake-endotracheal-intubation

"For the intraoral approach, the patient requires sufficient mouth opening to allow adequate visualization and access to the base of the posterior tonsillar pillars (palatopharyngeal arch) (Figure 7). After adequate topical anesthesia (lidocaine spray) has been applied, the tongue is retracted medially with a laryngoscope blade or a tongue depressor, allowing access to the posterior tonsillar pillar. Then, using a 22- or 25-gauge needle, 2–5 mL of 2% lidocaine are injected submucosally, after negative aspiration. The point of injection is at the caudal aspect of the posterior tonsillar pillar (approximately 0.5 cm lateral to the lateral edge of the tongue where it joins the floor of the mouth; (Figure 8). This is then repeated on the other side."

This is what I do for AFOI, if it helps.

 

[pastafan]

"Base of the tongue? Do you mean the posterior tonsillar pillar?"

Yes, that is what I meant. The problem is between secretions and tongue movement in this patient I had trouble visualizing area to be injected. Usually the nerve is partially visible through the mucosa but this time I could only get brief glimpses of target area.

 

[Arch Guillotti]

Usually the nerve is partially visible through the mucosa.

It is?