Local Anaesthetic
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what is in a LA
type - ester or amide vasoconstrictor - felypressin or adrenaline preservative - propylparaben, bisulphite
what is mainly used in the maxilla to achieve anaesthetic
pulp and buccal mucosa - buccal infiltration palatal mucosa - palatal injection
what is used in the mandible to achieve anaesthetic
pulp - posterior - IADB, middle - mental block, anterior - buccal infiltration buccal mucosa - long buccal infiltration lingual mucosa - lingual infiltration when administering IADB
what types of injections are commonly used and what is the difference
infiltration - anaesthetising terminal nerve ends block - anaesthetising nerve trunk, any branches distal to this are blocked
what are the steps required prior to injecting
check patients medical history - no contraindications check batch number and expiry date of LA record these set up equipment, with safety plus system dry mucosa apply topical for 1-2 minutes calm the patient and reassure, distraction and breathing
what is the technique for administering LA
stretch mucosa, have needle orientated with bevel away from bone, quickly pierce mucosa, once in correct place, aspirate, then slowly drip the LA in
why must aspirate be carried out
checks for blood in the cartridge, if so, in a blood vessel, must come out, change cartridge, and re-orientate
what size of needles are used
25mm - infiltration 35mm - block
where should a buccal infiltration be administered
reflect the mucosa, into the mucosa below apex of tooth - if lower - slightly distal
what are the positives and limitations of buccal infiltration
positives - easy technique, atraumatic, can get good topical anaesthetic limitations - dense bone, periapical abscess
what are the landmarks in an IADB
coronoid notch, posterior border of ramus of mandible, pterygomandibular raphe, premolars on the opposite side
where are you aiming to deposit the LA in an IADB
mandibular foramen
how should the LA needle be orientated in IADB
handle along the premolars on the opposite side, needle 1cm above the occlusal surface of molars
how can the lingual nerve be anaesthetised during IADNB
after 3/4 of cartridge is deposited, take the needle out 3-4mm, then deposit the remainder of cartridge, this should target the lingual nerve
how can you confirm anaesthesia
numb, tingly, shouldnt extend past the midline, if doing extraction, could probe the PDL, but if restoration, could do damage
what is the % of lidocaine used and what is its safe dosage
2% lidocaine with 1 in 80,000 adrenaline 5mg/kg safe
what is the % of prilocaine used and what is its safe dosage
3% prilocaine with felypressin/octapressin 8mg/kg safe
what is the % of articaine used and what is its safe dosage
4% articaine with 1 in 100,000 adrenaline 7mg/kg
what are the dangers of articaine
high percentage, unsure of the damage to nerves, shouldnt be used as a block until confirmed
give some examples of systemic complications with LA
psychogenic stress - increase HR, blood away from brain, may cause unconsciousness allergy, toxicity, drug interactions - beta blockers, cocaine, antidepressants
what are some examples of local complications with LA
trismus - damage to medial pterygoid muscle nerve damage - injecting into nerve, prolonged anaesthesia facial palsy - into soft tissue, diffuse through to parotid and through facial nerve intravenous - worsened systemic complications, anxiety, increased HR, pale