Local Anesthesia Introduction

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LOCAL ANESTHESIALOCAL ANESTHESIA



LOCAL ANESTHESIALOCAL ANESTHESIA

DEFINATIONDEFINATION Local Anesthesia has been defined asLocal Anesthesia has been defined as

loss of sensation in circumscribedloss of sensation in circumscribed

area of the body caused by aarea of the body caused by a

depression of excitation in nervedepression of excitation in nerve

endings or an inhibition of theendings or an inhibition of the

conduction process in peripheralconduction process in peripheral

nerves.nerves.



METHODS OF INDUCTIONMETHODS OF INDUCTION

• Mechanical traumaMechanical trauma

• Low temperatureLow temperature

• AnoxiaAnoxia• Chemical irritantsChemical irritants

• Neurolytic agentsNeurolytic agents

• Alcohol, henolAlcohol, henol

• Chemical agentsChemical agents• Local AnesthesiaLocal Anesthesia



ELECTROPHYSIOLOGYELECTROPHYSIOLOGY

OF NERVE CONDUCTIONOF NERVE CONDUCTION• A nerve possesses a resting negativeA nerve possesses a resting negative

electrical potential of ! "# Mvelectrical potential of ! "# Mv

•

produced by difference ofproduced by difference ofconcentration of ions on either sideconcentration of ions on either side

of the membrane.of the membrane.

• $he interior of the nerve is negative$he interior of the nerve is negative

relative to the exterior.relative to the exterior.



%&'(&NC& )* &+&N$%&-$A$)N/%&'(&NC& )* &+&N$%&-$A$)N/

• 0eploari1ation0eploari1ation• An initial phase of slow deploari1ation.An initial phase of slow deploari1ation.

$he electrical potential within the nerve$he electrical potential within the nerve

becomes slightly less negative.becomes slightly less negative.• Na ions influx causes depolari1ation toNa ions influx causes depolari1ation to

23# to 24#m v.23# to 24#m v.

• *iring threshold*iring threshold• 0ecrease of $rans membrane potential0ecrease of $rans membrane potential

to 253 mv from 2"# to 233mv/ isto 253 mv from 2"# to 233mv/ isre6uired.re6uired.

• An electrical potential of 78# m+ occursAn electrical potential of 78# m+ occurson the interior of the nerve cell.on the interior of the nerve cell.



• 9&)LA9:A$)N;9&)LA9:A$)N;

• $he electrical potential becomes more$he electrical potential becomes more222ve inside the nerve cell.222ve inside the nerve cell.

• Caused by inactivation of increasedCaused by inactivation of increased

permeability to Na.permeability to Na.• )riginal resting potential of 2"#mv is)riginal resting potential of 2"#mv is

achieved.achieved.



SITE OF ACTION OFSITE OF ACTION OF

LOCAL ANESTHETICSLOCAL ANESTHETICS$he nerve membrane is the site at which$he nerve membrane is the site at whichlocal anesthetics exert theirlocal anesthetics exert theirpharmacological action.pharmacological action.

$he calcium displacement theory$he calcium displacement theory• LA causes displacement of calcium fromLA causes displacement of calcium from

some membrane site that controlledsome membrane site that controlledpermeability to sodium.permeability to sodium.

$he surface charge repulsion/ theory$he surface charge repulsion/ theory• LA acts by binding to the nerve membraneLA acts by binding to the nerve membrane

and changes the electrical potential atand changes the electrical potential at

membrane surface.membrane surface.



$he membrane expansion theory$he membrane expansion theory• LA molecules diffuse to hydrophobicLA molecules diffuse to hydrophobic

regions of excitable membranes, producingregions of excitable membranes, producinga general disturbance of the membranea general disturbance of the membranestructure which in turns prevents Nastructure which in turns prevents Naimpermeability.impermeability.

%pecific receptor theory,%pecific receptor theory,• %pecific 9eceptor site for LA agents exists in%pecific 9eceptor site for LA agents exists in

the Na channel either on its external orthe Na channel either on its external orinternal surface.internal surface.

• LA acts by binding to specific receptors onLA acts by binding to specific receptors on

the Na channel.the Na channel.• LA binds to the receptors, permeability toLA binds to the receptors, permeability to

Na ions is decreased and nerve conductionNa ions is decreased and nerve conductionis interrupted.is interrupted.



MODE OF ACTION OFMODE OF ACTION OF

LOCAL ANESTHETICSLOCAL ANESTHETICS

Local anesthetics interfere withLocal anesthetics interfere with

excitation process in nerve membraneexcitation process in nerve membrane

in one or more of the following ways<in one or more of the following ways<• Altering the basic resting potential of theAltering the basic resting potential of the

nerve membranenerve membrane

• Altering the threshold potentialfiring level/Altering the threshold potentialfiring level/

• 0ecreasing the rate of depolari1ation0ecreasing the rate of depolari1ation

• rolonging the rate of repolari1ationrolonging the rate of repolari1ation



MECHANISM OF ACTION OFMECHANISM OF ACTION OF

LOCAL ANESTHETICLOCAL ANESTHETIC=y producing a conduction bloc> by decreasing the=y producing a conduction bloc> by decreasing thepermeability of the ionic channels to Na7 ions ;2permeability of the ionic channels to Na7 ions ;2

• 0isplacement of calcium ions from the sodium0isplacement of calcium ions from the sodiumchannel receptor site.channel receptor site.

•

=inding of the local anesthetics molecules to this=inding of the local anesthetics molecules to thisreceptor site.receptor site.• =loc>ade of the sodium channel=loc>ade of the sodium channel• 0ecrease in sodium conductance0ecrease in sodium conductance• 0epression of the the rate of electrical0epression of the the rate of electrical

depolari1ationdepolari1ation• *ailure to achieve the threshold potential level.*ailure to achieve the threshold potential level.• Lac> of development of action potential.Lac> of development of action potential.• Conduction bloc>ade.Conduction bloc>ade.



ROLE OF PH INROLE OF PH IN

LOCAL ANESTHETIC ACTIVITYLOCAL ANESTHETIC ACTIVITY• Normal h ".8Normal h ".8• LA without a vasoconstrictor 2 ph 3.3LA without a vasoconstrictor 2 ph 3.3• LA with a vasoconstrictor 2 h ?.? due toLA with a vasoconstrictor 2 h ?.? due to

antioxidant to inhibit oxidation of vasopressor.antioxidant to inhibit oxidation of vasopressor.

• nflamed tissue acidic/ 2 @ 3 to 4nflamed tissue acidic/ 2 @ 3 to 4• hen inBected into a tissue ,the bufferinghen inBected into a tissue ,the bufferingcapacity of the tissue fluids rapidly returns the hcapacity of the tissue fluids rapidly returns the hto normal ".8.to normal ".8.

• Acidification of tissue or LA decreases LAAcidification of tissue or LA decreases LA

properties<2properties<2• %lower onset of anesthesia%lower onset of anesthesia• rolongs its effectiveness.rolongs its effectiveness.• =urning sensation on inB=urning sensation on inB



ONSET, DURATION ,RECOVERYONSET, DURATION ,RECOVERY

FROM LAFROM LA• LA with greaterLA with greater lipid solubilitylipid solubility producesproduces

rapid onset of action.rapid onset of action.

• $he degree of$he degree of protein bindingprotein binding of localof local

anesthetic molecule is responsible for theanesthetic molecule is responsible for theduration of anesthetic activity .duration of anesthetic activity .

• 9ecovery starts when ntraneural LA9ecovery starts when ntraneural LAstarts diffusing outside.starts diffusing outside.

• Mantle proximally innervated regions !earlyMantle proximally innervated regions !earlyrecoveryrecovery

• core bundles distal region !later.core bundles distal region !later.

• +asodilator activity+asodilator activity



CLASSIFICATION OF LOCALCLASSIFICATION OF LOCAL

ANESTHETICS ANESTHETICS• &%$&9%&%$&9%

&%$&9% )* =&N:)C AC0&%$&9% )* =&N:)C AC0=utacaine=utacaineCocaineCocaine

ben1ocaineben1ocaine$etracaine$etracaine iperocaineiperocaine

&%$&9% )* A9AAMN)=&N:)C AC0&%$&9% )* A9AAMN)=&N:)C AC0ChloroprocaineChloroprocainerocainerocaine

ropoxycaineropoxycaine



AM0&%AM0&% LignocaineLignocaine

ArticaineArticaine

=upivacaine=upivacaine MepivacaineMepivacaine

rilocainerilocaine



METABOLISM OF LAMETABOLISM OF LA

• &%$&9%&%$&9% • @ydrolysis in the plasma by the en1yme pseudo@ydrolysis in the plasma by the en1yme pseudo

cholinesterase.cholinesterase.• rocaine hydrolysis to eraaminoben1oic acid A=A/.rocaine hydrolysis to eraaminoben1oic acid A=A/.

• AM0&%AM0&%• $he primary site of biotransformation is liver.$he primary site of biotransformation is liver.• atients with low hepatic blood flow @ypotension,ccf /atients with low hepatic blood flow @ypotension,ccf /

or poor liver function Cirrhosis/ are unable toor poor liver function Cirrhosis/ are unable tobiotransforme amides at normal rate 2 increase toxicity.biotransforme amides at normal rate 2 increase toxicity.

• ContraindicationContraindication

Liver dysfunctionLiver dysfunction @eart failure .@eart failure .



EXCRETIONEXCRETION

$he >idneys are primary$he >idneys are primary

excretory organ for bothexcretory organ for both

the local anesthetic and itsthe local anesthetic and its

metabolites .metabolites .

A percentage of a givenA percentage of a givendose of local anesthetic isdose of local anesthetic is

excreted unchanged in theexcreted unchanged in the

urine.urine.



+A%)C)N%$9C$)9%+A%)C)N%$9C$)9%



EFFECTS OFEFFECTS OF

VASOCONSTRICTORSVASOCONSTRICTORS• +asoconstriction decreases blood flow+asoconstriction decreases blood flow

perfusion/ to the site of administration.perfusion/ to the site of administration.

• 0ecrease absorption of the LA into cvs0ecrease absorption of the LA into cvs

• Lower anesthetic blood levels.Lower anesthetic blood levels.• Minimum ris> of LA toxicity.Minimum ris> of LA toxicity.

• ncreases duration of action as increasedncreases duration of action as increased

amounts of LA remain in and around theamounts of LA remain in and around thenerve for longer periodsnerve for longer periods

• 0ecreases bleeding 2+asoconstrition0ecreases bleeding 2+asoconstrition



CHEMICAL STRUCTURECHEMICAL STRUCTURE

&pinephrine, nor epinephrine, and&pinephrine, nor epinephrine, and

dopamine are the naturally occurringdopamine are the naturally occurring

catecholamines of the sympatheticcatecholamines of the sympathetic

nervous system.nervous system. soproterenol and levonordefrin aresoproterenol and levonordefrin are

synthetic catecholamines.synthetic catecholamines.

*elypressin is a synthetic analogue of*elypressin is a synthetic analogue of

vasopressin antidiuretic hormone/,vasopressin antidiuretic hormone/,



DILUTION OFDILUTION OF

VASOCONSTRICTORSVASOCONSTRICTORS

A concentration of 5;5### meansA concentration of 5;5### means

that there is 5 gram 5### mg/ ofthat there is 5 gram 5### mg/ of

solute drug/ contained in 5### ml ofsolute drug/ contained in 5### ml of

solution.solution. 5;5##,### concentrationD#.#5mgE5;5##,### concentrationD#.#5mgE

ml of vasoconstrictor.ml of vasoconstrictor.



CLASSIFICATION OFCLASSIFICATION OF

VASOCONSTRICTORSVASOCONSTRICTORS &pinephrine adrenaline/&pinephrine adrenaline/

Nor epinephrine,Nor epinephrine,

phenyl ephrine,phenyl ephrine, Levonordefrine,Levonordefrine,

)ctapressin.)ctapressin.



PHARMACOLOGY OFPHARMACOLOGY OF

ADRENALINE ADRENALINE

Acidic solutions are relatively stableAcidic solutions are relatively stable

if protected from air.if protected from air.

%odium bisulfite is added to delay its%odium bisulfite is added to delay its

deterioration.deterioration.

$he shelf life of LA$he shelf life of LA• ith adrenaline 25F monthsith adrenaline 25F months

• ithout adrenaline 2?4 months.ithout adrenaline 2?4 months.



MODE OF ACTIONMODE OF ACTION

EPINEPHRINEEPINEPHRINE &pinephrine acts directly on both alpha and&pinephrine acts directly on both alpha and

=eta2adrenergic receptors.=eta2adrenergic receptors. = effects predominate.= effects predominate. Activation of A receptor causesActivation of A receptor causes

• Contraction of smooth muscles in blood vesselsContraction of smooth muscles in blood vesselsvasoconstriction 2 @aemostasis/vasoconstriction 2 @aemostasis/

Activation of = receptor causesActivation of = receptor causes• 9elaxation of smooth muscles in blood vessels9elaxation of smooth muscles in blood vessels

vasodilatation ! 9eactive @yperemia !ost )pvasodilatation ! 9eactive @yperemia !ost )p

bleeding after 4 hrs/bleeding after 4 hrs/• Cardiac stimulation.Cardiac stimulation.



SYSTEMIC ACTIONS OFSYSTEMIC ACTIONS OF

EPINEPHRINEEPINEPHRINE ncreased systolic and diastolic pressuresncreased systolic and diastolic pressures ncreased cardiac outputncreased cardiac output ncreased stro>e volumencreased stro>e volume

ncreased heart ratencreased heart rate ncreased strength of contractionncreased strength of contraction ncreased myocardial oxygen consumptionncreased myocardial oxygen consumption

ncreased incidence ofncreased incidence of• dysrhythmiasdysrhythmias

• +entricular tachycardia+entricular tachycardia

• premature ventricular contractions.premature ventricular contractions.



OVERDOSE &OVERDOSE &

SIDE EFFECTSSIDE EFFECTS CN% stimulationCN% stimulation

• anxiety, tension, restlessness,, tremor,anxiety, tension, restlessness,, tremor,• wea>ness, di11iness, pallorwea>ness, di11iness, pallor• throbbing headachethrobbing headache

alpitation, cardiac dysrhythmias.alpitation, cardiac dysrhythmias. cerebral hemorrhage.cerebral hemorrhage.

• systolic G?## mm @g/systolic G?## mm @g/• diastolic GH##mm @g/diastolic GH##mm @g/

=ecause of the rapid inactivation of=ecause of the rapid inactivation ofepinephrine, the stimulatory phase of theepinephrine, the stimulatory phase of theoverdose toxic/ reaction usually is brief.overdose toxic/ reaction usually is brief.



SAFE DOSESAFE DOSE

Maximal epinephrine doses be limited toMaximal epinephrine doses be limited to#.H mg per appointment.#.H mg per appointment.

Max epinephrine dose be limited to #.)8Max epinephrine dose be limited to #.)8mg per appointment in cardiovascularmg per appointment in cardiovascularpatients.patients.

=lood ressure and heart rate, however,=lood ressure and heart rate, however,are minimally affected at these dosages.are minimally affected at these dosages.

t is currently thought that thet is currently thought that the

cardiovascular effects of conventionalcardiovascular effects of conventionalepinephrine doses are of little practicalepinephrine doses are of little practicalconcern, even in patients with heartconcern, even in patients with heartdisease.disease.



NOR EPINEPHRINENOR EPINEPHRINE

$he actions of nor epinephrine are almost$he actions of nor epinephrine are almost

exclusively on alpha receptors I#J/exclusively on alpha receptors I#J/

=lood pressure.=lood pressure.

• =oth systolic and diastolic pressures are=oth systolic and diastolic pressures areincreased 2alpha receptor stimulation causingincreased 2alpha receptor stimulation causing

peripheral vasoconstrictionperipheral vasoconstriction

$he extravascular inBection of$he extravascular inBection of

norepinephrine into tissues producesnorepinephrine into tissues producesnecrosis and sloughing.necrosis and sloughing.

• %terile palatal abscess%terile palatal abscess



SELECTION OF ASELECTION OF A

VASOCONSTRICTORVASOCONSTRICTOR Length of procedureLength of procedure

• lain HJ lig 25# min !hardEpulplain HJ lig 25# min !hardEpulp• HJ lig7 vasocont 24#min !hardEpulpHJ lig7 vasocont 24#min !hardEpulp

@emostasis re6uirement@emostasis re6uirement Medical states contraindications/Medical states contraindications/

• Cardiovascular disease A%A and +/Cardiovascular disease A%A and +/

• $hyroid dysfunction, diabetes and sulfite sensitivity/$hyroid dysfunction, diabetes and sulfite sensitivity/• KA drug interaction/KA drug interaction/

MA) inhibitors, tricyclic antidepressants andMA) inhibitors, tricyclic antidepressants andphenothia1ines.phenothia1ines.

@alothane, isoflurane, or enflurane2+en 0ys@alothane, isoflurane, or enflurane2+en 0ys• *elypression*elypression

Minimum cardiovascular stimulatoryMinimum cardiovascular stimulatory 9ecommended drug for A%A + cardiovascular ris>9ecommended drug for A%A + cardiovascular ris>

patients.patients.



L)CALL)CAL

AN&%$@&$CAN&%$@&$C

AK&N$%AK&N$%



LA DRUGS AVAILABLELA DRUGS AVAILABLE

HJ LignocaineHJ Lignocaine

8J Articaine8J Articaine

#.3J =upivacaine#.3J =upivacaine ?J M&+ACAN&?J M&+ACAN&

8J rilocaine8J rilocaine

DURATION OF ACTIONDURATION OF ACTION



DURATION OF ACTIONDURATION OF ACTION ndividual response to drugndividual response to drug

Accuracy in deposition of the localAccuracy in deposition of the localanestheticanesthetic

%tatus of the tissues at the site of drug%tatus of the tissues at the site of drug

depositiondeposition

• nflamation, infectionnflamation, infection

• vascularityvascularity

• p@p@

$ype of inBection administered$ype of inBection administered• supraperiostealsupraperiosteal

• infiltrationinfiltration

• nerve bloc>nerve bloc>



DURATION OF CLINICALDURATION OF CLINICAL

ANESTHESIA ANESTHESIA

HJ LigHJ Lig 0uration of Analgesiamin/0uration of Analgesiamin/

pulpal 2 soft tissuepulpal 2 soft tissue

325# 4#25H#325# 4#25H#

HJ Lig 4# 5F#2?##HJ Lig 4# 5F#2?## with 5;5##,###with 5;5##,###



MAX RECOMMENDED DOSAGEMAX RECOMMENDED DOSAGE

LignocaineLignocaine mgE>gmgE>g M90 mg/M90 mg/

No +aso 8.8 ?##No +aso 8.8 ?##

ith +aso 4.4 3##ith +aso 4.4 3##



CALCULATION OF LACALCULATION OF LA

( 1.8 ml CARTRIDGE)( 1.8 ml CARTRIDGE)

HJ LigHJ Lig mgEmlmgEml x5.FmlDmgEcartridgex5.FmlDmgEcartridge

H#mg ?4mgH#mg ?4mg



TOPICAL ANESTHETICSTOPICAL ANESTHETICS

=en1ocaine=en1ocaine

Cocaine @clCocaine @cl LignocaineLignocaine

$etracaine @cl$etracaine @cl




$opical anesthesia are effective only on surface tissues$opical anesthesia are effective only on surface tissuesH to ? mm/H to ? mm/

$he re6uired concentration of topical LA is greater than$he re6uired concentration of topical LA is greater thanLA administered by inB.LA administered by inB.

0o not contain vasoconstrictors.0o not contain vasoconstrictors.

@igher concentration@igher concentration• facilitates diffusion of the drug through the mucousfacilitates diffusion of the drug through the mucous

membranemembrane

• 9apid higher blood levels achieved as compare to inB9apid higher blood levels achieved as compare to inB

• increases the ris> of toxicityincreases the ris> of toxicity Many LA are ineffective topicallyMany LA are ineffective topically

• articaine, mepivacaine, prilocaine and procaine.articaine, mepivacaine, prilocaine and procaine.



FACTORS IN SELECTION OF LAFACTORS IN SELECTION OF LA

Length of time pain control isLength of time pain control isnecessarynecessary

otential need for post treatmentotential need for post treatment

pain controlpain control ossibility of self2mutilation in theossibility of self2mutilation in the

postoperative periodpostoperative period

9e6uirement for hemostasis9e6uirement for hemostasis resence of any contraindications toresence of any contraindications to

LA.LA.

FACTORS IN SELECTION OFFACTORS IN SELECTION OF



FACTORS IN SELECTION OFFACTORS IN SELECTION OF

LALA

hen postoperative pain is consideredhen postoperative pain is consideredli>ely, #.3J bupivacaine for F to 5H hoursli>ely, #.3J bupivacaine for F to 5H hours

of soft2tissue anesthesia/of soft2tissue anesthesia/

*or patients in whom postoperative*or patients in whom postoperative

anesthesia is a potential ha1ard, shorter2anesthesia is a potential ha1ard, shorter2duration anesthetics should be considered.duration anesthetics should be considered.

• younger children who might accidentally biteyounger children who might accidentally bite

or chew their lips or tongue.or chew their lips or tongue.

• atients on dialysisatients on dialysis

• ? J mepivacaine or 8 J prilocaine is? J mepivacaine or 8 J prilocaine is

recommended.recommended.



T! ARMAMENTARIUMT! ARMAMENTARIUM



SYRINGS AVAILABLESYRINGS AVAILABLE Non disposable syringesNon disposable syringes

• =reech2loading metallic E plastic, cartridge type=reech2loading metallic E plastic, cartridge type aspirating positive aspiration 5#J to 53J/aspirating positive aspiration 5#J to 53J/

self aspiratingself aspirating

• ressure syringe for periodontal ligament inBectionressure syringe for periodontal ligament inBection

• et inBector needle lessO syringe/et inBector needle lessO syringe/ 0isposable syringes0isposable syringes

%afetyO syringes%afetyO syringes

Computer controlled local anesthetic deliveryComputer controlled local anesthetic deliverysystemssystems



NEEDLE GAUGENEEDLE GAUGE %tainless steel needles 2 recommended%tainless steel needles 2 recommended KaugeKauge

• Kauge is diameter of lumen of the needle;Kauge is diameter of lumen of the needle;

• %maller the number , the greater the diameter of the%maller the number , the greater the diameter of thelumen.lumen.

• H32,H"2, and ?#2gauge needles are recommended.H32,H"2, and ?#2gauge needles are recommended.

• H" gauge yellow / ! most commonly used long needleH" gauge yellow / ! most commonly used long needle

• ?# gauge blue / ! most commonly used short needle?# gauge blue / ! most commonly used short needle

• H3 gauge red / ! hen ris> of positive aspiration !NerveH3 gauge red / ! hen ris> of positive aspiration !Nerve=loc>=loc>

• ?#2 and H"2 gauge needles are more li>ely to brea> than?#2 and H"2 gauge needles are more li>ely to brea> thanH32gauge needles.H32gauge needles.

NEEDLE LENGTHNEEDLE LENGTH



NEEDLE LENGTHNEEDLE LENGTH LengthLength

• %hort needle 2 H# mm%hort needle 2 H# mm• Long needle 2 ?H mmLong needle 2 ?H mm

A long needle ! hen penetration of significant thic>nessesA long needle ! hen penetration of significant thic>nessesof soft tissue re6uiredof soft tissue re6uired• nferior alveolar bloc>nferior alveolar bloc>• Kow2Kates techKow2Kates tech• A>inosiA>inosi

• nfra orbital, and maxillary nerve bloc>s .nfra orbital, and maxillary nerve bloc>s . %hort needles 2H# mm 2$hin soft tissue%hort needles 2H# mm 2$hin soft tissue

• nfiltrationnfiltration Needles should not be inserted into tissues to their hubsNeedles should not be inserted into tissues to their hubs 9ecapping is a accomplished using the scoopO techni6ue9ecapping is a accomplished using the scoopO techni6ue

0isposed in ;20isposed in ;2• contaminated containers , sharp containerscontaminated containers , sharp containers

CARTRIDGE CONTENTSCARTRIDGE CONTENTS



CARTRIDGE CONTENTSCARTRIDGE CONTENTS 0rug0rug

• LA agentLA agent

A vasoconstrictor vasopressor/ drug.A vasoconstrictor vasopressor/ drug. 9educing Agent antioxidant/9educing Agent antioxidant/

• $o avoid oxidation of adrenaline on exposure to$o avoid oxidation of adrenaline on exposure tosunlight !=rown color soln/.sunlight !=rown color soln/.

reservativereservative

• Na meta bisulphite is added.Na meta bisulphite is added.• t prevents oxidation of vasopressor by consumingt prevents oxidation of vasopressor by consumingoxygen.oxygen.

• Na meta bisulphite 7oxygen 222Na =isulphateNa meta bisulphite 7oxygen 222Na =isulphate =acteriostaticE *ungicidal Agent=acteriostaticE *ungicidal Agent

•Methylparaben #.5J 5mgEml/ ,$hymol..Methylparaben #.5J 5mgEml/ ,$hymol..

+ehicle+ehicle• 9ingers soln isotonic/9ingers soln isotonic/



CARTRIDGE PRECATUIONSCARTRIDGE PRECATUIONS

AutoclavedE boiledAutoclavedE boiled• Local anesthetic drug is stableLocal anesthetic drug is stable• )ther components of the cartridges are)ther components of the cartridges are

destroyed e.g vasopressor , cartridge sealsdestroyed e.g vasopressor , cartridge seals

• 0iscomfort nerve damage0iscomfort nerve damage %torage%torage

• n their original containern their original container• At room temperatureAt room temperature

• Avoid direct sunlightAvoid direct sunlight 0onPt 9euse0onPt 9euse Cartridges colorCartridges color



ANATOMICALANATOMICALCONSIDERATIONSCONSIDERATIONS



BASICBASIC

INJECTIONINJECTION

TECHNIQUESTECHNIQUES



TYPES OF LOCAL ANESTHESIATYPES OF LOCAL ANESTHESIA $opical or surface$opical or surface nfiltration anesthesia 2 Near terminal nerve endingsnfiltration anesthesia 2 Near terminal nerve endings

• %ub mucous inBection%ub mucous inBection

• %upra periosteal inBection%upra periosteal inBection

• %ub periosteal inBection%ub periosteal inBection

• ntra osseous inBectionntra osseous inBection

• ntra septal inBectionntra septal inBection

• ntra Ligamentary nBectionntra Ligamentary nBection 9egional or =loc> anesthesia9egional or =loc> anesthesia

• LA deposited close to a main nerve trun>LA deposited close to a main nerve trun>

• osterior superior alveolarosterior superior alveolar• inferior alveolarinferior alveolar

• nasopalatine .nasopalatine .




$opical anesthetic$opical anesthetic• Applied by applicator stic> !*or 5 minute.Applied by applicator stic> !*or 5 minute.• )nset H min)nset H min• 0uration 5# min0uration 5# min

&ster 2 =en1ocaine .&ster 2 =en1ocaine . Amides 2 LidocaineAmides 2 Lidocaine Allergic reactions to esters G greater thanAllergic reactions to esters G greater than

amideamide

Lignocaine topical anestheticsLignocaine topical anesthetics• Max 9ecommended 0o1e 2 H##mgMax 9ecommended 0o1e 2 H##mg• Aerosol ;2 5# mg E spray.Aerosol ;2 5# mg E spray.• )intment ;2 3# mg E ml)intment ;2 3# mg E ml



BASIC IN"ECTION TECHNI#UEBASIC IN"ECTION TECHNI#UE

• (se a sterili1ed sharp needle.(se a sterili1ed sharp needle.• Chec> the flow of local anestheticChec> the flow of local anesthetic

solutionsolution• 0etermine whether to warm the0etermine whether to warm the

anesthetic cartridges or syringe.anesthetic cartridges or syringe.• osition the patientosition the patient

• osition of 0rosition of 0r• 0ry tissue0ry tissue



BASIC IN"ECTION TECHNI#UEBASIC IN"ECTION TECHNI#UE

• Apply topical anesthehticApply topical anesthehtic• Communication with the patientCommunication with the patient• Ma>e the tissue taut.Ma>e the tissue taut.• Qeep the syringe out of sightQeep the syringe out of sight• nsert the needle into the mucosansert the needle into the mucosa• AspirateAspirate

• %lowly deposit the LA 22%lowly deposit the LA 22• )bserve the patient after the inBection)bserve the patient after the inBection

2222



PATIENT POSITIONPATIENT POSITION

%upine osition%upine osition

• @ead and heart parallel to the floor@ead and heart parallel to the floor

• *eet slightly elevated*eet slightly elevated

(pright position(pright position

• Causes Cerebral ischemiaCauses Cerebral ischemia

• =lood pressure in cerebral arteries is=lood pressure in cerebral arteries is

decreased by H mm @g for each inchdecreased by H mm @g for each inchabove the level of the heart.above the level of the heart.



ADMINISTRATOR POSITION ADMINISTRATOR POSITION

(pper 6uadrants2L$ 2 5# oRcloc>(pper 6uadrants2L$ 2 5# oRcloc>

(pper 6uadrant 9$ 2 F oRcloc>(pper 6uadrant 9$ 2 F oRcloc>

osture uprightosture upright Mirror E*ingers to retract chee>Mirror E*ingers to retract chee>



NEEDLE INSERTIONNEEDLE INSERTION

& ASPIRATION& ASPIRATION

Ma>e the tissue taut.Ma>e the tissue taut. =evel of the needle towards bone=evel of the needle towards bone

nferior alveolar nerve bloc>nferior alveolar nerve bloc>

• Average depth of needle insertion H#2H3 mmAverage depth of needle insertion H#2H3 mm AspirationAspiration

• $he thumb ring pulled bac> gently 52H mm$he thumb ring pulled bac> gently 52H mm

//

• %ign of blood in cart 7ve aspiration.%ign of blood in cart 7ve aspiration.

• 9emove and reinsert needle.9emove and reinsert needle.



DEPOSITE THE SOLUTIONDEPOSITE THE SOLUTION

%lowly inBect.%lowly inBect.

5 ml of local anesthetic solution in5 ml of local anesthetic solution in

4# seconds.4# seconds.

5.F ml cartridge re6uires approx H5.F ml cartridge re6uires approx H

min but usually 4# secmin but usually 4# sec

9ecap by SscoopP techni6ue9ecap by SscoopP techni6ue

• slide the needle tip into the cap withoutslide the needle tip into the cap without

touching the captouching the cap



OBSERVE THE PATIENTOBSERVE THE PATIENT

observe the patient closelyobserve the patient closely

atients should never be leftatients should never be left

unattended after inB.unattended after inB.

Most adverse drug reactions, with inMost adverse drug reactions, with in

3 min of inB3 min of inB



TECHNIQUESTECHNIQUESOFOF

MAXILLARYMAXILLARY

ANESTHESIAANESTHESIA

SUPRAPERIOSTEAL IN"ECTION



SUPRAPERIOSTEAL IN"ECTIONSUPRAPERIOSTEAL IN"ECTION

TECHNI#UETECHNI#UE ndication<2rocedures confined to smallndication<2rocedures confined to small

circumscribed areacircumscribed area H3 or H"2gauge 2 topical anestheticH3 or H"2gauge 2 topical anesthetic

Lift the lip, pulling the tissue taut.Lift the lip, pulling the tissue taut.

@old the syringe parallel with the long axis@old the syringe parallel with the long axisof the tooth 2bevel faces bone.of the tooth 2bevel faces bone.

nsert the needle into the height of thensert the needle into the height of the

muco buccal fold over the target tooth.muco buccal fold over the target tooth.

Advance the needle until its bevel is at orAdvance the needle until its bevel is at or

above the apical region of the toothabove the apical region of the tooth

0eposit #.4 to 5 ml over H# seconds.0eposit #.4 to 5 ml over H# seconds.

ANESTHESIA OF PALATAL



ANESTHESIA OF PALATAL ANESTHESIA OF PALATAL

TISSUESTISSUES $ight adherent mucoperiosteum2 pain full$ight adherent mucoperiosteum2 pain full $echni6ue$echni6ue

• $opical anesthesia !Maintain pressure$opical anesthesia !Maintain pressure

• bevel faces bone.E right angle to bonebevel faces bone.E right angle to bone• Advance the needle at the apical region of theAdvance the needle at the apical region of thetooth mid way between gingival margin midtooth mid way between gingival margin midpalate.palate.

• %lowly inB #.83 to #.4 ml in G ?# sec.%lowly inB #.83 to #.4 ml in G ?# sec.

Avoid inB close to greater palatine foramenAvoid inB close to greater palatine foramen• %oft palate numbness E swallowing difficult%oft palate numbness E swallowing difficult

• alatal inB not beyond Halatal inB not beyond Hndnd molar.molar.

MAXILLARY IN" TECHNI#UESMAXILLARY IN" TECHNI#UES




BUCCALBUCCAL

%upra periosteal infiltration/%upra periosteal infiltration/ eriodontal ligament inB.eriodontal ligament inB.

ntra septal crestal inBectionntra septal crestal inBection

ntra osseous inBectionntra osseous inBection

osterior superior alveolar nerve bloc>osterior superior alveolar nerve bloc>

• *or all Molars*or all Molars

Middle superior alveolar nerve bloc>Middle superior alveolar nerve bloc>

• *or pre molars, mesio buccal root of 5*or pre molars, mesio buccal root of 5stst

molar/molar/ Anterior superior alveolar infraorbital/ nerveAnterior superior alveolar infraorbital/ nerve

bloc>bloc>

• *or Anterior teethEremolarsEsoft tissues*or Anterior teethEremolarsEsoft tissues





PALATALPALATAL

Kreater palatine nerve bloc>Kreater palatine nerve bloc>• *or teeth distal to canine*or teeth distal to canine

Nasopalatine nerve bloc>Nasopalatine nerve bloc>

• *or canine to canine bilaterally*or canine to canine bilaterally Anterior middle superior alveolar nerve bloc>Anterior middle superior alveolar nerve bloc>• *or Anterior teeth*or Anterior teeth

alatal anterior superior alveolar nerve bloc>alatal anterior superior alveolar nerve bloc>• *or Anterior teeth*or Anterior teeth

POSTERIOR SUPERIORPOSTERIOR SUPERIOR



POSTERIOR SUPERIORPOSTERIOR SUPERIOR

ALVEOLAR NERVE BLOC$ ALVEOLAR NERVE BLOC$ Areas anestheti1edAreas anestheti1ed

• max ?rd, Hnd , 5st molars except mesiomax ?rd, Hnd , 5st molars except mesiobuccal root/buccal root/

• =uccal periostium and bone=uccal periostium and bone $echni6ue difficult ;no bony landmar>s$echni6ue difficult ;no bony landmar>s

during nBduring nB $arget area$arget area

•%A nerve2posterior,%A nerve2posterior,

• superior, and medial to the posterior border of thesuperior, and medial to the posterior border of themaxillamaxilla

9is> of hematoma9is> of hematoma



TECHNI#UESTECHNI#UES

OFOFMANDIBULARMANDIBULAR




BLOC$SBLOC$S

nferior alveolarnferior alveolar ncisivencisive

Kow ! KatesKow ! Kates

+a1irani ! A>inosi+a1irani ! A>inosi MentalMental

=uccal=uccal

nfiltrationnfiltration

• Not effective E increased density ofNot effective E increased density of

buccal cortical bonebuccal cortical bone

INFERIOR ALVEOLAR NERVEINFERIOR ALVEOLAR NERVE




BLOC$BLOC$ Nerves anestheti1edNerves anestheti1ed

• nf Alv, Lingual, ncisive, Mentalnf Alv, Lingual, ncisive, Mental

Area anestheti1edArea anestheti1ed

• Mand teeth, Ant HE?Mand teeth, Ant HE?rdrd tongue, *loor,tongue, *loor,

Lingual soft tissuesLingual soft tissues

ositive Aspiration 5#J to 53Jositive Aspiration 5#J to 53J

*ailure rate 53J to H#J*ailure rate 53J to H#J





BLOC$ %TECHNI#UEBLOC$ %TECHNI#UE

H3 gE long E barrel towards boneH3 gE long E barrel towards bone 9t AN= ! F o cloc>2 Lt AN= ! 5# o Cloc>9t AN= ! F o cloc>2 Lt AN= ! 5# o Cloc> ide mouth openingide mouth opening Landmar>sLandmar>s

• Coronoid notchCoronoid notch• terygomandibular rapheterygomandibular raphe• )cclusal plane)cclusal plane

@eightEAntero posterior site of N@eightEAntero posterior site of N• lace index E thumb in coronoid notchlace index E thumb in coronoid notch• An imaginary line from finger tip to pterygomandibularAn imaginary line from finger tip to pterygomandibular

rapheraphe• Needle insertion point2 ?E8Needle insertion point2 ?E8thth distance on the line fromdistance on the line from

fingerfinger• t is 4 to 5# mm above occlusal planet is 4 to 5# mm above occlusal plane




enetration depthenetration depth

• =one contact=one contact

• enetration up to H#2H3 mmenetration up to H#2H3 mm =one contacted too soon ! $ip anterior=one contacted too soon ! $ip anterior

=one not contacted ! $ip posterior=one not contacted ! $ip posterior

ithdraw needle ! 5 mmithdraw needle ! 5 mm

AspirateAspirate

0eposit 5.3 ml in 4# sec0eposit 5.3 ml in 4# sec *or lingual nerve*or lingual nerve

• ith draw needle at half way, deposit #.5 mlith draw needle at half way, deposit #.5 ml

Labial numbness lin ual sulcusLabial numbness lin ual sulcus

INFERIOR ALVEOLAR NERVE

BLOC$ %TECHNI#UEBLOC$ %TECHNI#UE



BUCCAL NERVE BLOC$BUCCAL NERVE BLOC$

=uccal nerve=uccal nerve• Ant branch of +?Ant branch of +?

• %ensory innervation to buccal soft%ensory innervation to buccal soft

tissues adB to molarstissues adB to molars• Not anestheti1ed in AN=Not anestheti1ed in AN=

nsertion ! Mucous membrane distalnsertion ! Mucous membrane distal

and buccal to last molarand buccal to last molar• 0epth 5 to H mm0epth 5 to H mm

0eposit0eposit• #.? ml in 5# sec#.? ml in 5# sec

GO GATES TECHNI#UEGO GATES TECHNI#UE



GO ' GATES TECHNI#UEGO ' GATES TECHNI#UE Nerves Anestheti1edNerves Anestheti1ed

• nf Al, Mental , ncisive, Ling, Mylohoid, Auriculo temp,nf Al, Mental , ncisive, Ling, Mylohoid, Auriculo temp,

=uccal.=uccal. ndicationsndications

• 9outine tech, unsuccessful nf Al bloc>9outine tech, unsuccessful nf Al bloc> $echni6ue$echni6ue

• ide mouth openingide mouth opening condyle anteriorly positionedcondyle anteriorly positioned comes close to mand nerve trun>comes close to mand nerve trun>

• $arget area ! lateral side of condylar nec>$arget area ! lateral side of condylar nec>• Needle insertionNeedle insertion

0istal to max H0istal to max Hndnd molar at the height of mesoi palatalmolar at the height of mesoi palatalcuspcusp

arallel to a line connecting corner of mouth andarallel to a line connecting corner of mouth andintertragic notchintertragic notch 0epth H3 mm E =one is contacted0epth H3 mm E =one is contacted

• Aspirate deposit 5.F ml in 4# secAspirate deposit 5.F ml in 4# sec• %low onset 3 min thic> nerve/%low onset 3 min thic> nerve/

VAIRANI A$INOSI TECHVAIRANI A$INOSI TECH



VAIRANI ' A$INOSI TECHVAIRANI ' A$INOSI TECH

(CLOSED MOUTH BLOC$)(CLOSED MOUTH BLOC$) ndicationsndications

• Limited mouth openingLimited mouth opening• nability to visuali1e landmar> for AN=nability to visuali1e landmar> for AN=

NervesEArea anestheti1edNervesEArea anestheti1ed• %ame as AN=%ame as AN=

$echni6ue$echni6ue• H3 g, long , target Area ! soft tissue on medial side of ramusH3 g, long , target Area ! soft tissue on medial side of ramus

• *ingerEthumb on coronoid notch, reflect soft tissue laterally*ingerEthumb on coronoid notch, reflect soft tissue laterally Needle insertionNeedle insertion

• =evel away from bone=evel away from bone

• %yringe parallel to max occlusal plane%yringe parallel to max occlusal plane

• nsert at height of mucogingival Bunction adBacent to max ?nsert at height of mucogingival Bunction adBacent to max ? rdrd molarmolar• 0epth0epth H3 mm , Mid of terygo mand spaceH3 mm , Mid of terygo mand space

• Aspirate 0eposit 5.F ml in 4# secAspirate 0eposit 5.F ml in 4# sec



$erminal branch of AN$erminal branch of AN

%ensory innervation !%ensory innervation !

• =uccal soft tissues anterior to foramen=uccal soft tissues anterior to foramen

• Lower lip, chinLower lip, chin

Area of insertion ! Mucobuccal foldArea of insertion ! Mucobuccal fold

until apices of ist Huntil apices of ist Hndnd premolarpremolar

0eposit 3 to 4 mm0eposit 3 to 4 mm

0eposit #.4 ml.0eposit #.4 ml.

MENTAL NERVE BLOC$MENTAL NERVE BLOC$



INCISIVE NERVE BLOC$INCISIVE NERVE BLOC$

$erminal branch of AN$erminal branch of AN Anestheti1es;2 remolars, canine,Anestheti1es;2 remolars, canine,

incisors soft tissuesincisors soft tissues n bilateral procedures;2n bilateral procedures;2 n =ilateral proceduresn =ilateral procedures

• bilateral incisive nerve bloc> forbilateral incisive nerve bloc> for

anestheti1ing premolar to premolar areaanestheti1ing premolar to premolar area• ncisive nerve bloc> on one side and ANncisive nerve bloc> on one side and AN

bloc> on other side.bloc> on other side.

SUPPLEMENTAL IN"SUPPLEMENTAL IN"



SUPPLEMENTAL IN"SUPPLEMENTAL IN"

TECHNI#UESTECHNI#UES As a sole techni6ueAs a sole techni6ue

$o supplement failed or partially$o supplement failed or partially

successful traditional nB $echsuccessful traditional nB $ech

• eriodontal ligament inBectioneriodontal ligament inBection

• ntraosseous inBectionntraosseous inBection

• ntra septal inBectionntra septal inBection

• ntra pulpal inBectionntra pulpal inBection



INTRA LIGAMENTARY IN"ECTIONINTRA LIGAMENTARY IN"ECTION•

$echni6ue$echni6ue• H" gauge Needle !Kingival sulcus , 3 secH" gauge Needle !Kingival sulcus , 3 sec

pressure!5EF th of car, one inB for each rootpressure!5EF th of car, one inB for each root

9apid on set2 within ?# sec2 0uration 8329apid on set2 within ?# sec2 0uration 832

33min33min %ingle tooth procedure%ingle tooth procedure

0isadvantages0isadvantages

• No numbness ,ain full , Cartridge brea>ageNo numbness ,ain full , Cartridge brea>age,tooth extrusion ,*ails in long rooted teeth,tooth extrusion ,*ails in long rooted teeth

PERIODONTAL LIGAMENTPERIODONTAL LIGAMENT



PERIODONTAL LIGAMENTPERIODONTAL LIGAMENT

IN"ECTIONIN"ECTION Area anestheti1edArea anestheti1ed

• =one, soft tissue, pulp=one, soft tissue, pulp

• =y diffusion through marrow, not period lig2=y diffusion through marrow, not period lig2

AvuAvu

ndicationsndications

• f pulpal anesthesia of one tooth re6uiredf pulpal anesthesia of one tooth re6uired

• Anesthesia in two lower, 6uadrantsAnesthesia in two lower, 6uadrants

• f soft tissue anesthesia not re6uired ! childrenf soft tissue anesthesia not re6uired ! children• f bloc> is contraindicated ! haemophilicsf bloc> is contraindicated ! haemophilics

• hen rapid onset of action re6uired.hen rapid onset of action re6uired.

0isadvantages0isadvantages



0isadvantages0isadvantages• Contra indicated in local infection, primaryContra indicated in local infection, primary

teethteeth

• 0ifficult needle placement0ifficult needle placement• =rea>age of glass needle ! HE?=rea>age of glass needle ! HE?rdrd empty.empty.• ost inBection discomfort, focal tissue damage,ost inBection discomfort, focal tissue damage,

tissue sloughing, extrusiontissue sloughing, extrusion $echni6ue$echni6ue

• Long axis of tooth, along interpoximal areaLong axis of tooth, along interpoximal area• %ingle rooted ! mesial or distal side%ingle rooted ! mesial or distal side• Multiple rooted ! =oth on mesial and distalMultiple rooted ! =oth on mesial and distal

sidessides

• 0eposit #.Hml in H# sec.0eposit #.Hml in H# sec.• &ffectiveness&ffectiveness

%ignificant resistance%ignificant resistance AdBacent soft tissue ischemiaAdBacent soft tissue ischemia

0uration ! 3 to 33 min for pulpal anesth0uration ! 3 to 33 min for pulpal anesth



INTRA SEPTAL IN"ECTIONINTRA SEPTAL IN"ECTION

(seful in providing osseous and soft(seful in providing osseous and soft

tissue anesthesiatissue anesthesia

*or periodontal curettageEsurgical*or periodontal curettageEsurgical

flap elevation.flap elevation. 83 angle to long axis over interdental83 angle to long axis over interdental

papillapapilla

Contact with boneContact with bone

INTRAL PULPAL IN"ECTIONINTRAL PULPAL IN"ECTION



INTRAL PULPAL IN"ECTIONINTRAL PULPAL IN"ECTION

Absence of inade6uate anesthesiaAbsence of inade6uate anesthesia

from other techni6uefrom other techni6ue

*it needle snugly into canals*it needle snugly into canals

9esistance during solution delivery9esistance during solution delivery

%eparate inBection for multiple canals%eparate inBection for multiple canals

mmediate actionmmediate action

COMPLICATION OF LOCALCOMPLICATION OF LOCAL



COMPLICATION OF LOCALCOMPLICATION OF LOCAL


Local complicationsLocal complications

%ystemic complications%ystemic complications



LOCAL COMPLICATIONLOCAL COMPLICATION

Needle brea>ageNeedle brea>age ersistent anesthesia or paresthesiaersistent anesthesia or paresthesia *acial nerve paralysis*acial nerve paralysis

$rismus$rismus %oft tissue inBury2 Lip =iting%oft tissue inBury2 Lip =iting =urning on inBection=urning on inBection nfection ! Leads to trismusnfection ! Leads to trismus %loughing of tissues%loughing of tissues ost anesthetic intral oral lesionsost anesthetic intral oral lesions

G



NEEDLE BREA$AGENEEDLE BREA$AGE

*ine needle for bloc>2 use H3 gauge*ine needle for bloc>2 use H3 gauge Needle bending redirectionNeedle bending redirection

Needle insertion up to hubNeedle insertion up to hub

%udden patient movement%udden patient movement

PARESTHESIA



PARESTHESIAPARESTHESIA

LA Contamination by alcohol ,LA Contamination by alcohol ,sterili1ing solnsterili1ing soln

$rauma to nerve 2 rare$rauma to nerve 2 rare

@aematoma leading to nerve@aematoma leading to nerve

compressioncompression

Neurotoxic effect of LA eg 8JNeurotoxic effect of LA eg 8J

prilocaineprilocaine

FACIAL NEVER PARALYSIS



FACIAL NEVER PARALYSISFACIAL NEVER PARALYSIS

nB in deep lobe of parotid glandnB in deep lobe of parotid gland n infra orbital nerve bloc> ! nBuryn infra orbital nerve bloc> ! nBury

to terminal branches ! Muscle droopto terminal branches ! Muscle droop

S STRISMUS



TRISMUSTRISMUS

nBection innBection in

• medial ptrygoid musclemedial ptrygoid muscle

• infra termporal fossainfra termporal fossa

@amorrhage , low grade infection,@amorrhage , low grade infection,

mycotoxic effect of LAmycotoxic effect of LA

@eat therapy , N%A0 , Muscle@eat therapy , N%A0 , Muscle

relaxant , physiotherapy antibioticsrelaxant , physiotherapy antibioticsif not improved in 8F hrs.if not improved in 8F hrs.

HAEMATOMAHAEMATOMA



HAEMATOMAHAEMATOMA

nBury E pric> to a vesselnBury E pric> to a vessel @aematoma formation untill@aematoma formation untill

hydrostatic pressure differencehydrostatic pressure difference

%welling%welling

!! intra oral in AN bloc>intra oral in AN bloc>

• &xtra oral in %AN bloc>&xtra oral in %AN bloc>

Causes trismusEainCauses trismusEain

BURNING SENSATIONBURNING SENSATION



BURNING SENSATIONBURNING SENSATION

9educed @ of soln9educed @ of soln 9apid inBection of LA9apid inBection of LA

Contamination of solnContamination of soln

armer solnarmer soln

TISSUE SLOUGHINGTISSUE SLOUGHING



TISSUE SLOUGHINGTISSUE SLOUGHING

EPTHELIAL DES#UAMATION EPTHELIAL DES#UAMATION

STERILE ABSCESSSTERILE ABSCESS $opical anesthetics$opical anesthetics

%econdary to prolong ischemia%econdary to prolong ischemia

epinephrine/epinephrine/

%een in palatal tissue%een in palatal tissue

%ymptomatic treatment ! recovery%ymptomatic treatment ! recovery"25# days"25# days

POST ANESTHETIC INTRA ORALPOST ANESTHETIC INTRA ORAL



POST ANESTHETIC INTRA ORALPOST ANESTHETIC INTRA ORAL

LESIONSLESIONS 9ecurrent apthous stomatitis9ecurrent apthous stomatitis

Apthous ulcers/Apthous ulcers/

@erpes simplex@erpes simplex

SYSTEMIC COMPLICATIONSYSTEMIC COMPLICATION



SYSTEMIC COMPLICATIONSYSTEMIC COMPLICATION

(nwanted effects due to LA agent(nwanted effects due to LA agent (nwanted effects not due to LA(nwanted effects not due to LA

agentagent

UNANTED EFFECTS DUEUNANTED EFFECTS DUE



UNANTED EFFECTS DUEUNANTED EFFECTS DUE

TO LA AGENTTO LA AGENT n normal individuals $ype A reaction/n normal individuals $ype A reaction/

• CN%CN% %timulation of cerebral cortex%timulation of cerebral cortex

• Apprehension, confusion , excitability , headache ,Apprehension, confusion , excitability , headache ,nausea , vomitting sweating , muscular twitching ,nausea , vomitting sweating , muscular twitching ,

visual disturbances , convulsionvisual disturbances , convulsion 0epression of medulla0epression of medulla

• 9esp centre ! resp depression9esp centre ! resp depression• +asomotor centre depression ! = falls , loss of+asomotor centre depression ! = falls , loss of

consciousnessconsciousness

• Cardio vascular system intra vascular inB/Cardio vascular system intra vascular inB/ @eart@eart

• Cardiac depression ! Cardiac arrestCardiac depression ! Cardiac arrest +ascular bed+ascular bed

• eripheral vasodilatation ! = *allseripheral vasodilatation ! = *alls



n abnormal individualsn abnormal individuals• 0rug Allergy @ypersensitivity/0rug Allergy @ypersensitivity/

• dio syncrasydio syncrasy (nexpected response of drug differing from(nexpected response of drug differing from

its pharmacological actionits pharmacological action

*ever, uriticaria , dermatitis , angioodema ,*ever, uriticaria , dermatitis , angioodema ,

anaphylaxisanaphylaxis

hoto sensitivityhoto sensitivity

UNANTED EFFECTS NOT DUEUNANTED EFFECTS NOT DUE



UNANTED EFFECTS NOT DUEUNANTED EFFECTS NOT DUE

TO LATO LA sychomotorsychomotor 0rug nteraction0rug nteraction +aso pressor effects+aso pressor effects

• Local effectsLocal effects +aso constriction initial/+aso constriction initial/

• allorallor

• Local cyanosisLocal cyanosis Later ! 9eactive @yperemiaLater ! 9eactive @yperemia

• ncreased ris> of post op bleedingncreased ris> of post op bleeding• Keneral effects inB in veinEraping absorption/Keneral effects inB in veinEraping absorption/

$achycardia palpation/$achycardia palpation/ ApprehensionApprehension = increased= increased

• Metabolic effectsMetabolic effects ncreased blood glucose levelncreased blood glucose level 0ecrease Q levels0ecrease Q levels

Documents

Local Anesthesia Introduction