Review of Greater Palatine Nerve Block

Greater Palatine Nerve Block Technique  

What it numbs: The greater palatine nerve block is used to anesthetize palatal tissue to the posterior portion of the hard palate distal to the canines and medial to midline. Anesthetic of the palatal soft and hard tissues is a necessary part of treatment to reduce our patient’s discomfort.  

Needle:

The recommended needle gauge and length are a 27 short.  

Positioning:

Patient position is supine with mouth wide open.

For the right greater palatine nerve block and right handed operator, sit at an 8 o'clock position directly facing the patient.

For the left greater palatine nerve block and right handed operator, sit at an 11 o'clock position directly facing the patient.  

Landmarks:

The landmark is the greater palatine foramen.  

Target area:

The target and injection site is the palatal soft tissue just anterior to the depression created by the greater palatine foramen.  

Dry tissue with 2×2 Gauze.  

Use a cotton tip applicator to palpate the tissue for the depression where the greater palatine foramen is located, place topical for at least one minute.  

Re-dry the tissue with a 2×2 guaze.

Get a new cotton tip to apply pressure anesthesia prior to and during the injection.  

Bevel orientation is toward the palatal soft tissue. As the needle is advanced thru soft tissue of the depression usually less than 5 mm with enough pressure to bow needle slightly.

On contacting bone and negative aspiration, deliver 1/4 to 1/3 of the cartridge over 20 seconds.

Aspiration potential is less than one percent for the greater palatine nerve block.  

Observe patient after injection.    

To increase the success and reliability of administering local anesthetic you need to learn to rely on the visualization and palpation of landmarks and tissues while injecting.

Document:

Document in patient record, what injection you gave, who gave it, what kindof anesthetic, how much anesthetic, negative aspiration, no complications, ect.

 

 For more information and references: 

 

Handbook of Local Anesthesia by Malamed  

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