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Local complications of Local Anesthesia
- 2. INTRODUCTION LOCAL COMPLICATIONS REFERENCES
- 3. Potent complications in local anesthesia administration local Complications systemic INTRODUCTION
- 5. Most annoying & depressing complications of regional anesthesia , but one of the easiest to prevent PREVENTION Do not attempt to force a needle against resistance. Do not attempt to change the direction of needle while it is embedded in the tissue Do not use a needle of too fine a gauge Do not use resterilizable needles
- 6. Do not attempt injections if you are uncertain about anatomy the area of the techniques employed Do not insert needles so far as it is out of sight in tissue Do not surprise patient with a sudden unexpected needle insertion Do not use short needles for inferior alveolar nerve block MANAGEMENT Immediate referral of patient to an appropriate specialist Locate retained fragment through panoramic &CT scanning Surgeon in the operating theatre removes the needle fragment under general anesthesia.
- 8. PARESTHESIA – defined as persistent anesthesia or altered sensation well beyond the expected duration of anesthesia CAUSES Trauma to nerve Contamination of local anesthetic solution by alcohol or sterilizing solution Trauma to nerve sheath Hemorrhage into or around the neural sheath
- 9. PROBLEM Lead to self inflicted nerve injury Biting or thermal or chemical insult PREVENTION Strict adherence to injection protocol & proper care & handling of dental cartridges.
- 10. MANAGEMENT Be reassuring Examine patient in person Reschedule the patient for examination every 2 months as long as sensory deficit persists Avoid readministration of local anesthetic into that region
- 11. CAUSE Introduction of local anesthetic into capsule of parotid gland PROBLEM Loss of motor function of muscles of facial expression PREVENTION Do not direct needle too posterior during IANB Do not overinsert during Vazirani – Akinosi nerve block
- 13. MANAGEMENT Reassure the patient Contact lenses should be removed until muscular movement occurs Eye patch should be applied to the affected eye
- 14. Prolonged tetanic spasm of the jaw muscles by which normal opening of mouth is restricted CAUSES Trauma to muscles or blood vessels Contamination of solution with alcohol or cold sterilizing agent Hemorrhage Low grade infection
- 15. PREVENTION Use sharp sterile disposable needle Use aseptic technique Practice atraumatic insertion and injection technique Avoid repeat injections and multiple insertions into same area Use minimum effective volumes of local anesthetic
- 16. MANAGEMENT Heat therapy Warm saline rinses Analgesics Muscle relaxants Physiotherapy Vazirani – Akinosi nerve block Antibiotics
- 17. CAUSE Persistence of soft tissue anesthesia than pulpal anesthesia PROBLEM Swelling & pain PREVENTION Selection of local anesthetic of appropriate duration Placing cotton roll between lips & teeth Warning the patient & parent
- 18. MANAGEMENT Analgesics Antibiotics Lukewarm saline rinses Petroleum jelly
- 19. Effusion of blood into extravascular spaces CAUSE Arterial or venous puncture PREVENTION Knowledge of normal anatomy Modifying injection technique according to patients anatomy Minimizing number of needle penetrations into tissue Never use needle as a probe in tissues Use a short needle for PSA nerve block
- 20. MANAGEMENT Application of pressure IANB – on medial aspect of mandibular ramus ASA nerve block – skin directly over infraorbital foramen Incisive / Mental nerve block – directly over mental foramen Buccal nerve block / any palatal nerve block – at site of bleeding PSA nerve block – difficult to apply pressure - applied on mucobuccal fold as far distally as possible
- 21. CAUSES Careless injection technique Use of dull needles Rapid deposition of local anesthetic solution
- 22. PREVENTION Adhere to proper techniques of injection Use sharp needles Use topical anesthetic before injection Use sterile local anesthetic solutions Using solution of correct temperature Use of buffered local anesthetic
- 23. CAUSES Acidic pH of solution Rapid injection of local anesthetic solution Contamination of local anesthetic catridges PREVENTION Buffering to a pH of 7.4 Slowing the speed of injection( recommended – 1.8ml/min) Catridges should be stored at room temperature in the container in which it was shipped or in a container without alchohol or other sterilizing agents
- 24. CAUSES Contamination of needle before administration Improper technique in handling local anesthetic Improper tissue preparation for injection Injecting local anesthetic agent into an area of infection PROBLEMS Low grade infection Trismus
- 25. PREVENTION Use sterile disposable needles Properly care for and handle needles Properly care and handle dental catridges of local anesthetic Properly prepare the tissues before penetration MANAGEMENT Heat Analgesics antibiotics – pencillin V physiotherapy
- 26. CAUSES Trauma during injection Infection Allergy Hemorrhage Injection of irritating solutions PROBLEM Pain Dysfunction Airway obstruction
- 27. PREVENTION Proper care & handle of local anesthetic Use of atraumatic injection technique Complete an adequate medical evaluation of patient before drug administration MANAGEMENT Analgesics Antibiotics Histamine blockers
- 28. If compromising breathing If unconscious patient is placed supine Airway,Breathing,Circulation Definitive treatment Epinephrine – adult 0.3 mg , child 0.15 mg Histamine blocker Corticosteroid
- 29. •Application of a local anesthetic to the gingival tissues for a longer period •Heightened sensitivity of the tissues to either topical or injectable local anesthetic •Secondary to prolonged ischemia •Usually develops on the hard palate Causes Epithelial desquamation Sterile abscess
- 30. PROBLEM Pain PREVENTION Topical anesthetics Do not use overly concentrated solutions containing vasoconstrictors MANAGEMENT symptomatic
- 31. CAUSES Recurrent aphthous stomatitis or Herpes simplex Trauma to tissues by a needles PROBLEM Acute sensitivity in the ulcerated area Risk of secondary infection minimal
- 32. PREVENTION Antiviral drugs MANAGEMENT Reassure the patient Topical LA Orabase (oinment) without Kenalog (corticosteroid) Tannic acid preparation (Zilactin)
- 33. Handbook of local anesthesia – Stanley F Malamed Images: www.google.com