Local Anesthesia

What are local anesthetics?

It produce loss of sensation to pain in a specific area of the body without the loss of consciousness

Role: Decrease intraoperative and postoperative pain Increase patients cooperation

Mode of dispensation

Local anesthesics maybe available as: Syringe form 2% viscous gel 5% ointment 10% liquid spray

Method of Action

Local anesthesia temporarily blocks the normal generation and conduction action of the nerve impulses and it is obtained by injecting the anesthetic agent near the nerve in the area intended for dental treatment.

Properties for ideal anesthestics

Effective Reversible Lack of irritation Rapid onset Adequate shelf life Effective Penetration into mucous membrane

Composition of Local Anesthesia

1. Local anesthetic agent- this is the active ingredient in the solution eg. Lignocaine. 2. Vasoconstrictor- adrenaline reduces toxicity and confines anesthetic agent to a localized area thus increasing depth and duration of anesthesia. 3. Anti-oxidant- vasoconstrictors are unstable in solution and may oxidize, especially on a prolonged exposure to sunlight. Sodium meta-bisulfite, protects solution from oxidation.

4. Preservative- methyl paraben keeps the solution in stable form. 5. Fungicide- thymol 6. Vehicle- normal saline or ringers lactate solution is used. Isotonic vehicle minimizes discomfort during injection.

The procedures requiring local anesthesia in dental clinic are:

Root canal treatment Removal of teeth Deep dental fillings Periodontal gum surgeries Crown and bridge work Implants gingivectomy Alveloplasty Dental cyst removal Pericoronitis Sticthing and muco-periosteal flapping

contraindication

Acute infection at the site of puncture

Hemophilia Uncontrolled diabetes Hypersensitivity to local anesthetics Severe hypertension Hyperthyroidism angina pectoris heart attack or stroke patients within 6 months of the event Patients taking digoxin

complications
Those attributed to the solution used Toxicity Allergy Infection caused by contaminated solution Local irritations or tissue reactions caused by solution

Those attributed to the insertion of the needle and technique.

Syncope Muscle trismus Pain Edema Infections Broken needles Prolonged anesthesia Hematoma Facial nerve palsy

Allergy to Local Anesthesia Defined as hypersensitive state acquired through exposure to particular antigen Symptoms: Rashes Urticaria edema Mucous membrane congestion a. Rhinitis b. Asthmatic symptoms

Clinical manifestations of toxicity

Fear/anxiety Restlessness Throbbing headaches Tremors Weakness Dizziness Pallor Respiratory difficulty/palpitations Tachycardia

Injectable Anesthesia techniques 1) Block

A. B. C. D. E. F.

Maxillary

posterior superior alveolar block middle superior alveolar block anterior superior alveolar block greater palatine block infraorbital block nasopalatine block

A. B. C.

Mandibular

D. E.

inferior alveolar block buccal block mental block incisive block Gow-Gates mandibular nerve block

2) infiltration

LOCAL INFILTRATION
In local infiltration, small terminal nerve endings in the area of the surgery are flooded with local anesthetic solution, making them insensitive to pain

Nerve block

Regional anesthesia or nerve block involves a larger area than infilteration ;however , it more precisely anesthetizes the entire distribution of a specific nerve. It is achieved by depositing the local anesthetic near the trunk of a major nerve.