Techiques LA

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Dr Afeefa
• Space
• Boundaries
• Contents
• Volume
• Direct/indirect techniques
• Landmarks
• Area anaesthetized
 INFERIOR ALVEOLAR NERVE BLOCK
-TECHNIQUE
• 25 g/ long / barrel towards bone
• Rt IANB – 8 o clock- Lt IANB – 10 o Clock
• Wide mouth opening
• Landmarks
– Coronoid notch
– Pterygomandibular raphe
– Occlusal plane
• Height/Antero posterior site of INJ
– Place index / thumb in coronoid notch
– An imaginary line from finger tip to pterygomandibular raphe
– Needle insertion point- 3/4th distance on the line from finger
– It is 6 to 10 mm above occlusal plane
 MENTAL NERVE BLOCK
• Terminal branch of IAN
• Sensory innervation –
– Buccal soft tissues anterior to foramen
– Lower lip, chin
• Area of insertion – Mucobuccal fold until
apices of ist & 2nd premolar
• Deposit 5 to 6 mm
• Deposit 0.6 ml.
 INCISIVE NERVE BLOCK
• Terminal branch of IAN
• Anesthetizes:- Premolars, canine, incisors &
soft tissues
• In bilateral procedures:-
• In Bilateral procedures
– bilateral incisive nerve block for anesthetizing
premolar to premolar area
– Incisive nerve block on one side and IAN block on
other side.
 INFERIOR ALVEOLAR NERVE BLOCK
-TECHNIQUE
• Penetration depth
– Bone contact
– Penetration up to 20-25 mm
• Bone contacted too soon – Tip anterior
• Bone not contacted – Tip posterior
• Withdraw needle – 1 mm
• Aspirate
• Deposit 1.5 ml in 60 sec
• For lingual nerve
– With draw needle & at half way, deposit 0.1 ml
• Labial numbness / lingual sulcus
 BUCCAL NERVE BLOCK
• Buccal nerve
– Ant branch of V3
– Sensory innervation to buccal soft tissues adj to
molars
– Not anesthetized in IANB
• Insertion – Mucous membrane distal and
buccal to last molar
– Depth 1 to 2 mm
• Deposit
– 0.3 ml in 10 sec
 GOW – GATES TECHNIQUE
• Nerves Anesthetized
– Inf Al, Mental , Incisive, Ling, Mylohoid, Auriculo temp, Buccal.
• Indications
– Routine tech, unsuccessful Inf Al block
• Technique
– Wide mouth opening
• condyle anteriorly positioned
• comes close to mand nerve trunk
– Target area – lateral side of condylar neck
– Needle insertion
• Distal to max 2nd molar at the height of mesoi palatal cusp
• Parallel to a line connecting corner of mouth and intertragic notch
• Depth 25 mm / Bone is contacted
– Aspirate & deposit 1.8 ml in 60 sec
– Slow onset 5 min (thick nerve)
 VAZIRANI – AKINOSI TECH
(CLOSED MOUTH BLOCK)
• Indications
– Limited mouth opening
– Inability to visualize landmark for IANB
• Nerves/Area anesthetized
– Same as IANB
• Technique
– 25 g, long , target Area – soft tissue on medial side of ramus
– Finger/thumb on coronoid notch, reflect soft tissue laterally
• Needle insertion
– Bevel away from bone
– Syringe parallel to max occlusal plane
– Insert at height of mucogingival junction adjacent to max 3rd molar
– Depth 25 mm , Mid of Pterygo mand space
– Aspirate & Deposit 1.8 ml in 60 sec
 PERIODONTAL LIGAMENT INJECTION
• Area anesthetized
– Bone, soft tissue, pulp
– By diffusion through marrow, not period lig- Avu
• Indications
– If pulpal anesthesia of one tooth required
– Anesthesia in two lower, quadrants
– If soft tissue anesthesia not required – children
– If block is contraindicated – haemophilics
– When rapid onset of action required.
• Disadvantages
– Contra indicated in local infection, primary teeth
– Difficult needle placement
– Breakage of glass needle – 2/3rd empty.
– Post injection discomfort, focal tissue damage, tissue
sloughing, extrusion
• Technique
– Long axis of tooth, along interpoximal area
– Single rooted – mesial or distal side
– Multiple rooted – Both on mesial and distal sides
– Deposit 0.2ml in 20 sec.
– Effectiveness
• Significant resistance
• Adjacent soft tissue ischemia
• Duration – 5 to 55 min for pulpal anesth
 INTRA SEPTAL INJECTION
• Useful in providing osseous and soft tissue
anesthesia
• For periodontal curettage/surgical flap
elevation.
• 45 angle to long axis over interdental papilla
• Contact with bone
 INTRAL PULPAL INJECTION

• Absence of inadequate anesthesia from other

technique
• Fit needle snugly into canals
• Resistance during solution delivery
• Separate injection for multiple canals
• Immediate action
COMPLICATION OF LOCAL ANESTHESIA

• Local complications
• Systemic complications
 LOCAL COMPLICATION
• Needle breakage
• Persistent anesthesia or paresthesia
• Facial nerve paralysis
• Trismus
• Soft tissue injury- Lip Biting
• Burning on injection
• Infection – Leads to trismus
• Sloughing of tissues
• Post anesthetic intral oral lesions
 NEEDLE BREAKAGE
• Fine needle for block- use 25 gauge
• Needle bending & redirection
• Needle insertion up to hub
• Sudden patient movement
• Management
 PARESTHESIA
• LA Contamination by alcohol , sterilizing soln
• Trauma to nerve - rare
• Haematoma leading to nerve compression
• Neurotoxic effect of LA eg 4% prilocaine
• Management
 FACIAL NEVER PARALYSIS
• Inj in deep lobe of parotid gland
• In infra orbital nerve block – Injury to terminal
branches – Muscle droop
• Management
 TRISMUS
• Injection in
– medial ptrygoid muscle
– infra termporal fossa
• Hamorrhage , low grade infection, mycotoxic
effect of LA
• Heat therapy , NSAID , Muscle relaxant ,
physiotherapy antibiotics if not improved in
48 hrs.
 HAEMOTOMA
• Injury / prick to a vessel
• Haematoma formation untill hydrostatic
pressure difference
• Swelling
– intra oral in IAN block
– Extra oral in PSAN block
• Causes trismus/Pain
• Management
 BURNING SENSATION
• Reduced PH of soln
• Rapid injection of LA
• Contamination of soln
• Warmer soln
 TISSUE SLOUGHING
EPTHELIAL DESQUAMATION / STERILE ABSCESS

• Topical anesthetics
• Secondary to prolong ischemia (epinephrine)
• Seen in palatal tissue
• Symptomatic treatment – recovery 7-10 days
• Management
 POST ANESTHETIC INTRA ORAL LESIONS

• Recurrent apthous stomatitis (Apthous ulcers)

• Herpes simplex
• Management
 SYSTEMIC COMPLICATION
• Unwanted effects/overdose
– Lignocaine
• CNS
• CVS
– Adrenalin
• Allergic reaction
– Bisulfite toxicity
– Adrenalin
– Latex allergy
– Topical
UNWANTED EFFECTS DUE TO LA AGENT
– CNS
• Stimulation of cerebral cortex
– Apprehension, confusion , excitability , headache , nausea , vomitting
sweating , muscular twitching , visual disturbances , convulsion
• Depression of medulla
– Resp centre – resp depression
– Vasomotor centre depression – BP falls , loss of consciousness
– Cardio vascular system (intra vascular inj)
• Heart
– Cardiac depression – Cardiac arrest
• Vascular bed
– Peripheral vasodilatation – BP Falls
Drug Allergy (Hypersensitivity)
– Idio syncrasy
• Unexpected response of drug differing from its
pharmacological action
• Fever, uriticaria , dermatitis , angioodema , anaphylaxis
• Photo sensitivity
• Management
 UNWANTED EFFECTS
• Psychomotor
• Drug Interaction
• Vaso pressor effects
– Local effects
• Vaso constriction (initial)
– Pallor
– Local cyanosis
• Later – Reactive Hyperemia
– Increased risk of post op bleeding
– General effects (inj in vein/raping absorption)
• Tachycardia (palpation)
• Apprehension
• BP increased
– Metabolic effects
• Increased blood glucose level
• Decrease K levels