Abstract
A greater auricular nerve (GAN) block was used as the sole anesthetic for facial surgery in an 80-year-old male patient with multiple comorbidities which would have made general anesthesia challenging. The GAN provides sensation to the ear, mastoid process, parotid gland, and angle of the mandible. In addition to anesthesia for operating room surgery, the GAN block can be used for outpatient or emergency department procedures without the need for a separate anesthesia team. Although this nerve block has been performed using landmark-based techniques, the ultrasound-guided version offers several potential advantages. These advantages include increased reliability of the nerve block, as well as prevention of inadvertent vascular puncture or blockade of the phrenic nerve, brachial plexus, or deep cervical plexus. The increasing access to ultrasound technology for medical care providers outside the operating room makes this ultrasound guided block an increasingly viable alternative.
Highlights
The greater auricular nerve (GAN) is the major sensory branch of the cervical plexus.[1]
The GAN is readily amenable to local anesthetic blockade as it lies in a superficial location passing over the sternocleidomastoid muscle
A GAN block can be used for multiple urgent care, emergency department and surgical procedures to enhance patient comfort, decrease pain, and decrease the need for intravenous anesthetics.[3]
Summary
The greater auricular nerve (GAN) is the major sensory branch of the cervical plexus.[1]. We describe the case of an 80 year-old male with multiple comorbidities who successfully underwent surgical resection of an ear skin lesion using ultrasound-guided GAN block. The patient was initially assessed by the faculty anesthesiologist upon arrival to the pre-operative area the day of surgery. He had an extensive past medical history including diabetes mellitus-type I, previous myocardial infarction which resulted in cardiac stent placement, congestive heart failure, pacemaker placement, mitral valve disease, hypertension, hypercholesterolemia, obstructive sleep apnea, and gout. After a discussion with the patient and surgeon, we decided to perform an ultrasound guided GAN block for excision of the skin lesions, allowing the patient to avoid general anesthesia. The surgery was performed uneventfully using only the nerve blocks and a small 12.5 microgram bolus of intravenous fentanyl
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