Local Anesthesia

Learning Objectives

You should know

Understand how local anaesthetics work

Know the potency, speed of onset & duration of action of common agents

Be aware of reasons for failure of anesthesia & complications that occur

Know the safe dosage of common local anesthetic drugs

Profound anesthesia is needed if the tooth is to be removed without pain.

Local anesthetic agent either reduce or abolish the excitability of nerve endings or
block the pathways along which painful impulses are conveyed to the brain
Anesthesia is loss of all form of sensation including pain, touch, temperature &
pressure perception.
Local anesthesia is widely employed for dental operation lasting upto 45 minutes
Definition
Loss of sensation in a circumscribed area of the body caused by a depression
of excitation in nerve endings or an inhibition of the conduction process in
peripheral nerves
Properties desirable for local anesthesia are:
1.It should not be irritating to the tissue to which it is applied.
2.It should not cause any permanent alteration of nerve structure.
3.Its systemic toxicity should be low.
4.It must be effective regardless of whether it is injected into the tissue or applied
locally to mucous membranes.
5.The time of onset of anesthesia should be as short as possible.
6.The duration of action must be long enough to permit completion of the procedure
yet not so long as to require an extended recovery.
Classification of Local Anesthetics
ESTERS

AMIDES

Butacaine

Articaine

Cocaine
Benzocaine

Bupivacaine
Etidocaine

Procaine

Lidocaine

Propoxycaine

Mepivacaine
Prilocaine

Contraindication to local anesthesia.

Presence of acute infection at the site of operation

Types of local anesthesia

Topical or surface anesthesia

Infiltration anesthesia

Intraligamentary or periodontal ligament injection

Regional or block anesthesia

Contents of local anesthesia

Local anesthetic agent

1. Lidocaine

Vasoconstrictors

1. Adrenaline ,synthetic alkaloid

2. Felypressin, synthetically produce polypeptide

Reducing agent i.e. sodium metabisulphite

Preservative i.e. methylparaben

Fungicide i.e. thymol

The vehicle i.e. modified ringers solution

Metabolism & Excretion

Ester
Metabolize in plasma by the enzyme pseudocholinesterase
Excreted in urine

Amide
Metabolize in liver only
Excreted in urine
Mode of action of local anaesthetic solution
Nerve impulse can be define as
a wave of electrical activity passing along a nerve fiber as the result of an
exchange of cations ( Na & K ) across the surface membrane of a nerve cell.
Initiation of nerve impulse increases the permeability of the surface membrane, Na
ions diffuse in & the polarity of the interior of the cell relative to the out side is
suddenly reversed, the inward rush of Na ion is balanced by the escape out ward of
K ions, this change in polarity is known as a wave of depolarization. The rapid
movement of the wave of depolarization along the nerve fiber constitutes the nerve
impulse
Anesthetic agent is a combination of weak base & a strong acid, which rapidly
hydrolyzed in alkalinity of human tissue to liberate the alkaloid base which prevents
the increase in permeability of nerve cell membrane & prevents the depolarization
& so on impulse is conducted
Maximum recommended doses of LA
Type

Max dose adults

Child(20kg)

2% lidoc
cartridges)

4.4mg/kg upto 300mg

2 cartridges

3% priloc

6.9mg/kg upto 400mg

1.8 cartridges

(7