Local Complications

in
Anesthesia Administration
Pro.Dr.Atef Hassanen
 Local Complications

Needle breakage
Pain on injection
Burning on injection
Persistent anesthesia or paresthesia
Lip chewing
 Local Complications

Trismus
Hematoma
Infection
Edema
Sloughing of tissues
 Local Complications

Facial nerve paralysis

Post-anesthetic intraoral lesions

Local Complications
Written documentation is mandatory
Follow-up care should be arranged
 Needle Breakage

Causes
Unexpected movement
Small needle size
Bent needles
Defective needles
 Needle Breakage

Prevention
Use large needles
Use long needles for deep injection,>18mm
Never insert to hub
Redirect only when adequately withdrawn
 Needle Breakage

Management
Remain calm
Don't explore
Have the patient keep opening wide
If the needle is out remove it
Refer to an Oral Surgeon
 Pain on Injection

Causes
Careless technique
Dull needles
Rapid deposit of solution
Needles with barbs
 Pain on Injection

Prevention
Careful technique
Sharp needles
Topical anesthetic
Slow injections
Room temperature solutions
 Burning on Injection

Causes
pH of solution
Rapid injection
Contamination
Warmed solutions
 Persistent Anesthesia
or Paresthesia
Causes
Trauma to nerve
Neurolytic agents (alcohol, phenol)
Intraneural injection
Hematoma
 Persistent Anesthesia
or Paresthesia
Prevention
Careful injection technique
Unavoidable at times
 Persistent Anesthesia
or Paresthesia
Management
Patient counseling and reassurance
Documentation
Follow-up
Appropriate referral
 Trismus

A motor disturbance of the trigeminal nerve

precipitating or resulting in spasm of
the muscles of mastication
 Trismus

Causes
Trauma to muscles or blood vessels
Contaminated anesthetic solutions
Hemorrhage
Infection
Excessive anesthetic volume
 Trismus

Prevention
Sharp needles
Proper care and handling of cartridges
Aseptic technique and clean injection site
Atraumatic insertion
Minimal injections and volume
 Trismus

Management
Examination
Conservative therapy
passive ROM therapy
analgesics
heat
muscle relaxants
 Hematoma

The effusion of blood into extravascular

spaces
 Hematoma

Prevention
Care with needle placement
Minimize injections
Don't probe with needle
Modify technique
short needles
penetration depth
 Hematoma

Management with
IAN block
Infraorbital block
Mental Nerve block
Buccal block
PSA block
 Infection

Causes
Needle contamination
Improper handling of armamentarium
Infection at injection site
Improper handling of tissue
 Infection

Prevention
Disposable needles
Proper care of equipment
Aseptic technique
 Infection

Management
Usual sign is trismus
Trismus persists (1-3 day resolution )
Antibiotics, if suspicious
 Edema

Causes
Trauma during injection
Infection
Allergy
Hemorrhage
Irritating solutions
 Edema

Management
Address cause
Treat accordingly
hemorrhage
allergy
infection
 Sloughing of Tissue

Causes
Topical anesthetic
Prolonged ischemia
 Sloughing of Tissue

Management
Observation
Documentation
 Lip Chewing

Management
Analgesics
Antibiotics
Saline rinses
Lip lubricants
 Facial Nerve Paralysis

Cause
Anesthesia of peripheral Facial nerve branches
Temporal
Zygomatic
Buccal
Mandibular
Cervical
 Facial Nerve Paralysis

Prevention
Bone contact when injecting
Avoid over penetration
Avoid arbitrary injection
 Facial Nerve Paralysis

Management
Reassure patient
Cornea care
Documentation
Consider deferring dental care
Post Anesthetic Intraoral Lesions

Recurrent apthous

Herpes Simplex