BLOCKING THE PATHWAY

OF PAINFUL IMPULSES
The most widely used method in dentistry for controlling
pain is blocking the pathway of painful impulses.
By this method a suitable drug, possessing local
analgesic properties, is injected into the tissues in
proximity to the nerve or nerves involved.
 The local anesthetic solution prevents depolarization of
the nerve fibers at the area of absorption, thus preventing
those particular fibers from conducting any impulses
centrally beyond that point.
As long as the solution is present in the nerve in sufficient
concentration to prevent depolarization, the block will be
in effect.
It is obvious that this method of pain control is possible
by interfering with pain perception.
oFor a maximum effect the injected local
anesthetic drug must come into contact
with at least 8 to 10 mm of the nerve to
block two or three adjacent nodes of
Ranvier Whenever a shorter length of the
nerve is affected, anesthesia will usually
be incomplete.
oWhen an inadequate concentration of
local anesthetic comes into contact with
the nerve fiber or when less than the
required minimal length of fiber is
affected, the block may be incomplete
This incomplete block may be manifested
by the patient being unaware of or
unresponsive to a single stimulus but
responsive to a series of stimuli
oWhen a nerve or nerve fibers are
incapable of conducting impulses
because of the effect of a local anesthetic
agent, a state of regional analgesia or
regional anesthesia exists over the area
innervated by these nerves.
o Can be divided into component
parts depending on:
1. the areas anesthetized,
2. the site of incision,
3. and the technique employed
 Nerve block The nerve block method
of securing regional analgesia consists
of depositing a suitable local
anesthetic solution within close
proximity to a main nerve trunk and
thus preventing afferent impulses from
traveling centrally beyond that point
Field block The field block method of
securing regional analgesia consists of
depositing solution in proximity to the
larger terminal nerve branches so that the
area to be anesthetized is walled off or
circumscribed to prevent the central
passage of afferent impulses Technically
speaking, when a local anesthetic solution
is deposited above the apex of the root of a
tooth, rendering it insensible to pain, the
resultant analgesia should be called a field
black because it fulfills all the criteria for
this particular method
Local infiltration in local infiltration small
terminal nerve endings in the area of the
surgery are flooded with local anesthetic
solution rendering them insensible to
pain or preventing them from becoming
stimulated and creating an impulse in this
method the incision is made through the
same area in which the solution has been
deposited.