Superior laryngeal nerve block

[excalibur]

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Anyone do these for AFOI? If so, do you inject underneath the Cornu of the hyoid bone or do you this other technique that I have seen where your needle hits the lamina of the thyroid cartilage and you walk the needle superiorly until you pierce the thyrogyoid membrane?

How effective is this block?

I did a nasal awake FO over weekend for mandibulat fx. Used precedex loading infusion, transtracheal block, and topical nasal lidocaine. Worked very well.

Was just wondering about practitioners' technique for SLN block

 

[risnwb]

We do these all the time. 25g needle with 2ml 2% lido, go in till you hit the cornu of the hyoid, pull back a mm, aspirate, inject. Works great. Combine with trans-trach and some oral atomized lido and they hardly feel anything. In my experience the AFOI is much smoother if blocks are done compared to topicalization alone. Don't see why you need to go through the thyrohyoid membrane if you can get the field block before the SLN goes through it...

 

[excalibur]

Saw the video on YouTube by an Australian doc named Laurie Poon

I tried once with technique you described, and I just felt I had difficulty palpating the Cornu of the hyoid. Did all the tricks that are mentioned, but I feel I must have missed it, because pt not numb when it went. I might have injected around thyroid cartilage instead of hyoid.

I guess this technique is done by this guy because thyroid cartilage is easier to palpate and recognize with the tip of your needle

 

[fakin' the funk]

Combine with trans-trach and some oral atomized lido and they hardly feel anything.

If you already have the lidocaine atomizer out, why in f*ck's name are you doing SLN and RLN blocks with needles?! Combine this with precedex and you have a brilliantly complicated solution to a simple problem. 👍

(yes I know you said why, perceived greater efficacy)

 

[excalibur]

Sometimes atomizer LTA doesn't quite get as far as you want and doesn't anesthetize SLN or RLN. I agree though that Precedex will help inadequate blocks and/or topicalization

 

[OB1🤙]

I start a lidocaine nebulizer in preop, continue to the room, then atomize. Has served me just fine without needles.

Precedex helps, this is true. TBH I haven't used it for this purpose as an attending. Too many moving parts for my liking.

 

[excalibur]

What u guys use? The MADD atomizer?

We have this Lido LTA kit, and I just don't feel like I am getting deep enough. The red straw for my hurricane spray doesn't get deep enough for me.

What r u guys using to atomize?

 

[Mr Wizard]

What u guys use? The MADD atomizer?

We have this Lido LTA kit, and I just don't feel like I am getting deep enough. The red straw for my hurricane spray doesn't get deep enough for me.

What r u guys using to atomize?

I also have a syringe of lido on the suction port of the bronch to give the cords a little misting before I go for the win.

 

[VentdependenT]

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[VentdependenT]

Sometimes atomizer LTA doesn't quite get as far as you want and doesn't anesthetize SLN or RLN. I agree though that Precedex will help inadequate blocks and/or topicalization

Not an LTA.

Take a nebulizer, put 5ml of 4% lido in it. Have pt breath it until bubbling stops. You can squirt lido on the cords with the FO for extra points.

 

[VentdependenT]

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