Laryngeal Nerve Block

The laryngeal nerve is a branch of the vagus nerve supplying the pharynx and larynx.^[287] Block of the laryngeal nerve allows laryngeal endoscopic examinations lasting no more than 30 minutes in a conscious patient. It can be particularly helpful when tracheal intubation is difficult because it allows an attempt at intubation in an awake patient. An easy and safe approach to this nerve consists of a subcutaneous injection of local anesthetic just lateral to the extremity of the hyoid horn. The intradermal needle is inserted perpendicular to the skin until it contacts the cartilage ( Fig. 45-25 ). After a negative aspiration test result, the anesthesiologist injects 0.1 to 0.2 mL/kg of 1% lidocaine (i.e., rather large volumes in this narrow area) subcutaneously, using up to a maximum of 8 mL of lidocaine.