Administration Of Local Anaesthetic In Children Flashcards
What are the uses of local anaesthesia?
Operative pain control
Diagnostic tool
Control of haemorrhage
What forms of intraoral surface anaesthesia can you get?
Spray
Gel
Solution
What kind of gel surface anaesthesia can you get for the mouth?
20% benzocaine gel
5% lidocaine analgesic gel
What kind of spray surface anaesthesia can you get?
10% lidocaine spray
Give an example of a skin surface anaesthesia can you get?
EMLA lidocaine 2.5%, Prilocaine 2.5%
Ametop Tetracaine
What types of conventional LA can you get?
Lidocaine hydrochloride 2% with adrenaline 1:80,000 (lignospan, xylocaine)- gold standard in UK, solution of choice
Plain lidocaine- short acting agent, no vasoconstrictor present
Prilocaine 3% with felypressin (Citanest with Octapressin)- no adrenaline, extra-hepatic metabolism
Mepivacaine HCl 3% (Scandonest 3% plain)- no adrenaline
Articaine 4% with 1:100,000 or 1:200,000 adrenaline (Articaine Septanest)- fast onset, profound anaesthesia, less LA used, claim better infiltrations in the mandible, less preservatives
Bupivavaine 0.25% with adrenaline 1:200,000 (Marcian) or without adrenaline- slow onset (30 mins), 3-7 hour duration
What are the different techniques of LA?
Infiltration anaesthesia- extravascular placement of LA in region to be anaesthetised
Regional block anaesthesia- deposition of LA into the tissues around individual nerves or nerve plexuses- IDB, long buccal, mental, incisive, maxillary
Intraligamentary anaesthesia
Intrapulpal
What is the aim of an infiltration?
Deposit LA near to apex, supra periostea
0.5-1ml sufficient for pupal anaesthesia
Buccal approach, closer to apices
What part of the maxilla can inhibit the spread of the infiltration?
Zygomatic buttress
In the primary dentition, what LA injections can be used in the mandible?
Buccal infiltration is usually adequate for primary molars
Buccal infiltrations are usually unreliable for permanent molars so >6 years old a regional block is usually used for primary molars
What is the technique for an inferior alveolar block in a child?
Same technique as for an adult
Direct approach from primary molars on opposite side, syringe parallel to occlusal plane
Insertion approx 5mm above occlusal plane
If contact bone immediately don’t withdraw completely, indirect technique
For young child, a short needle may be used
Usually easier in child as the mandibular foramen is below the occlusal plane
What is the technique for a lingual block in a child?
Withdraw half-way following IDB, aspirate and deposit remaining solution
What is the technique for a long buccal in a child?
Equates to an infiltration in a child
What is the technique for a mental block in a child?
Needle advanced in buccal sulcus between 1st and 2nd molar apices
Excellent soft tissue anaesthesia
Problem with incisors due to cross over supply
What is the technique for a maxillary block in a child?
Regional blocks are rarely used in child
Greater palatine and nasopalatine blocks are avoided by infiltrating LA through already anaesthetised papillae
Pressure with mirror as distraction if palatal block required
What is the technique for intraligamentary anaesthesia in a child?
Intraosseous injection with LA entering with PDL
Recommended dose is 0.2ml/root
What are examples of needle free LA devices?
Jet injectors
Index systems
What are some advantages of needle free LA devices?
Mucosa anaesthetised to depth of 1cm without use of needle
Deliver jet under high pressure
Conventional LA solution used
What are some disadvantages of needle free LA devices?
Expensive
Technique not applicable to all areas
Soft tissue damage if careless technique
Specialised syringes can be frightening
Loud noice and bad taste following delivery
What is an example of a computerised injection system?
The wand- Fine needle- pen like Easier for operator Anaesthetic delivered under controlled pressure Decreased post-op numbness Lower pain ratings Less disruptive behaviour
What are the advantages of intraligamentary anaesthesia?
Less uncomfortable than IDB or palatal
Rapid onset and less effect on soft tissue, decreased self-mutilaton
Used in patients where IDB is contraindicated
Can come in pen grip or pistol grip syringes
What are some disadvantages of intraligamentary injections?
If immature root or short, risk of avulsion
Risk of damage to permanent successor
What are some tips and tricks for LA in children?
Avoid LA at the first visit if possible
Has to be a clinical decision- age of child and cooperation, urgency and type of treatment, parental input, maxillary infiltration as 1st experience if possible
Good preparation of child
Good technique
How should the administration of LA be carried out in a child?
Organise equipment and material
-Sharp fine needle (30 gauge)
-Aspirating syringe- disposable
-Allow LA to reach room temperature
-Keep out of sight
Establish good operator/patient position
-Patient 30 degrees to vertical
-Sit/stand in front at 8 o’clock position
-Assistant present to restrain hands if necessary
Inform child
-Explanation depends on age
-Tooth going to sleep, patient awake
-Explain/show topical gel- sparkly feeling
-Patient on board
