Ultrasound Guided Bilateral Superior Laryngeal Nerve Block Compared with Blind Block Technique for Awake Fibre-optic Intubation in Suspected Difficult Intubation

Abstract

irway anesthesia is pivotal for successful awake intubation provided either topically or by nerves blocks. Airway blocks are considered technically more difficult to perform and carry a higher risk of complications. However, in experienced hands, they can be useful as they provide excellent intubating conditions. Ultrasound has been widely used to locate nerves for various nerve blocks. The potential advantages of using ultrasound imaging for nerve blocks include reduction in the amount of local anesthetic required, improved success rate, reduced time to perform the block and reduced complication rate. We describe the successful performance of ultrasound-guided bilateral superior laryngeal nerve block to facilitate awake fibre-optic intubation. Superior laryngeal nerve block can be performed easily, safely and with a high success rate in patients with normal air way anatomy. In those with difficult landmarks, ultrasound can be of assistance. For the superior laryngeal nerve block, other targets than the nerve itself must be established to make the technique successful, easy to teach, learn and perform. Ultrasound imaging for superior laryngeal nerve block is more likely to be successful, takes less time to perform, and has a faster onset, longer duration, and fewer complications (such as intravascular or intra-neural injection) than the anatomical land mark method.