Content continues after advertisement

Adequate Analgesia for Ear Procedures

William Oldenhoff, DVM, DACVD, Madison Veterinary Specialists in Monona, Wisconsin

Sign in to Print/View PDF

In the Literature

Layne EA, de Miguel Garcia C. Clinical techniques in veterinary dermatology: regional anaesthesia of the canine ear. Vet Dermatol. 2019;30(6):470-e138.


This study describes a technique for performing regional anesthesia in canine ears, which is particularly important during otoscopy and deep ear flushing. Otoscopic procedures can be painful and require profound sedation or anesthesia. Regional nerve blocks with lidocaine and bupivacaine block sensation to the affected area and allow for decreased anesthetic doses. These blocks may also be useful in dogs undergoing total ear canal ablation and bulla osteotomy. The 2 nerves that provide sensory innervation of the ear canal and pinna are the great auricular nerve and auriculotemporal nerve.

To block the great auricular nerve, the transverse process of the atlas (C1) should be palpated. A 22 g × 3.5” spinal needle is inserted at the skin caudal to C1 and aimed toward the deep fascia at the level of the transverse process of C1. Needle insertion is superficial, with the tip of the needle pointing rostrally. Negative aspiration of blood should be ensured. The total dose is injected in 3 equal amounts along the transverse process as the needle is retracted.

To block the auriculotemporal nerve, the temporomandibular joint (TMJ) is first localized by opening and closing the mouth while palpating the area over the TMJ. After locating the TMJ, a 22 g × 1.5” spinal needle should be inserted perpendicular to the skin toward the TMJ. The needle should be held in contact with the zygomatic arch at the level of the masseteric margin. After negative aspiration of blood is ensured, the drug can be injected.

Lidocaine or bupivacaine can be used. The upper dose limit is 5 mg/kg for lidocaine and 2 mg/kg for bupivacaine. The desired total volume for injection for the great auricular nerve is 0.2 mL/kg; the volume for the auriculotemporal nerve is 0.04 mL/kg. The dose can be diluted with saline to achieve total volume in cases in which the upper limit of the dose prohibits using the desired volume of the drug by itself (eg, in smaller dogs).


Key pearls to put into practice:


Deep ear flushing in dogs with severe otitis can be painful and thus requires significant sedation or anesthesia. The ear blocks described can allow for lower doses to be administered; as a result, recovery can be improved and anesthetic depth can be lighter.


Ear flushing is an underused tool to treat chronic otitis and should be considered in any patient that has chronic otitis or suspicion of otitis media.


For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.


Clinician's Brief:
The Podcast

Listen as host Beckie Mossor, RVT, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Privacy Policy (Updated 05/08/2018) Terms of Use (Updated 05/08/2018)