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BDS 2: Preparing for Patients > LA Symposium > Flashcards

LA Symposium Flashcards

1
Q

What is the difference between a local infiltration and a regional nerve block?

A

A local infiltration is where the LA diffuses through the thin outer cortical bone and pools around the nerves entering at the root apex.
A regional nerve block is where the anaesthetic pools around the nerve supplying a specific area.

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2
Q

What teeth can local infiltration be used on?

A

Potentially all maxillary teeth, and anterior mandibular teeth where the bone is thin enough.

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3
Q

What type of needle is used for local infiltrations?

A

27G short (25mm) needle

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4
Q

What are the 2 types of local infiltration?

A
  • Buccal infiltration (needle placed superior to apex)

- Palatal infiltration (painful, needle placed midway between tooth and median palatine raphe, inject slowly)

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5
Q

What are the 3 maxillary nerve block techniques?

A
  • Nasopalatine nerve block
  • Infraorbital nerve block
  • Posterior superior alveolar nerve block (PSAN)
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6
Q

Describe the nasopalatine nerve block.

A
  • 25G short needle
  • Nasopalatine nerve is a branch of the maxillary nerve
  • Enters the oral cavity through the incisive foramen in the hard palate
  • Insert needle 1cm into nasopalatine canal
  • Used for profound anaesthesia of the palate
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7
Q

Describe the infraorbital nerve block.

A
  • 25G long (35mm) needle
  • Branches off the maxillary nerve
  • Profound anaesthesia of face, lip, gingivae and teeth
  • Insert needle 1cm from alveolar ridge of maxillary canine, 2cm deep, deposit
  • Rarely used, mostly for oral surgery on anterior teeth
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8
Q

Describe the posterior superior alveolar nerve block.

A
  • PSAN block
  • Rarely used, indicated for profound anaesthesia of maxillary molars
  • 25/27G short needle
  • Needle placed into mucobuccal fold distal to second molar
  • Insert 2cm
  • Deposit 1-2ml
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9
Q

What are the 5 mandibular nerve block techniques?

A
  • Inferior dental/alveolar/lingual nerve block
  • Long buccal nerve block
  • Mental nerve block
  • Sublingual nerve block
  • Gow-Gates technique
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10
Q

Describe the inferior alveolar nerve block and lingual nerve block.

A
  • Main technique used, anaesthetises all lower teeth
  • Deposition of LA around the IAN as it enters the mandibular foramen beneath the lingula
  • Pt opens as wide as possible
  • 25G long needle
  • Place thumb on cornoid notch
  • Point needle at the pterygomandibular space (triangle), inject lateral to the pterygomandibular raphe into the pterygomandibular depression
  • For lingual nerve sink to 5mm depth
  • Deposit 0.5ml solution
  • Handle of needle angled between the premolars
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11
Q

Describe the long buccal nerve block.

A
  • Generally used in conjunction with ID block
  • Anaesthetises gingivae buccal to mandibular molars
  • 25G long needle
  • Place needle posterior and buccal to last standing molar
  • Inject 1ml
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12
Q

Describe the mental nerve block.

A
  • Indicated for lower lip surgery, biopsies and surgery of anterior portion of denture bearing area
  • Does NOT anaesthetise teeth
  • 25G short needle
  • Needle inserted between the lower premolars in the mucobuccal fold
  • 1ml deposited
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13
Q

Describe the sublingual nerve block.

A
  • Anaesthetises anterior portion of lingual nerve
  • 25G short needle
  • Needle inserted lingually to the premolars
  • Inject 0.5ml
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14
Q

Describe the Gow-Gates technique.

A
  • Pt opens as wide as possible
  • Anaesthetises entire mandibular nerve
  • Use thumb to located coronoid process, insert needle mesial to this
  • Depth of approx. 25mm until condyle is contacted
  • Inject 2ml
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15
Q

What is the difference in length between a short and long needle?

A

Short: 25mm
Long: 35mm

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16
Q

What should always be done prior to injecting anaesthetic and why?

A

Aspirate. Ensures that you don’t inject into a blood vessel.

17
Q

What is intraligamentry anaesthesia?

A
  • Uses specialist intraligamentary syringe and ultrafine needle, teeth must be plaque free
  • Anaesthetises individual teeth
  • Solution deposited along PDL under high pressure
  • Risk of temporary extrusion, discomfort
  • Potentially increased risk of dry socket when this technique is used for extractions
18
Q

What is intraosseus anaesthesia?

A
  • Anaesthetises individual teeth
  • Motor-driven perforator used to penetrate buccal gingiva and outer cortical plate
  • Injected directly into porous cancellous bone, easily diffuses to root apex
19
Q

Which topical anaesthetics are used in the dental hospital?

A
  • Lidocaine ointment 5% (applied to dry mucosa, wait for 2-5 minutes)
  • Benzocaine 20% w/v (only under staff supervision)
20
Q

What are the usual LA doses for an infiltration and nerve block?

A

Local infiltration = 1ml

Nerve block = 1.5-2ml

21
Q

What adjustments should be made if your patient has taken cannabis, cocaine, inhalants or performance enhancing drugs in the past 24 hours?

A

Avoid using LA containing epinephrine.

22
Q

When would you decrease the number of maximum cartridges to 2 cartridges containing epinephrine, or 3 cartridges containing felypressin?

A

For elderly or medically compromised patients: e.g. hypertension myocardial infarction in the past 6 months, stable angina, taking calcium channel blockers, taking beta blockers, taking non-potassium sparing diuretics.

23
Q

For which patients should LA containing epinephrine never be used, and felypressin with caution?

A

Patients with unstable angina, uncontrolled arrhythmias or phaechromocytoma.

24
Q

Which LA is recommended for pregnant or breastfeeding patients?

A
  • Lidocaine 2% with adrenaline (1:80000) can be used with caution in early pregnancy and nursing mothers
  • Prilocaine with felypressin (citanest 3% with octapressin) should not be used in early pregnancy, and not recommended as the best choice for any pregnant patients
25
Q

What must be included in your notes when LA is administered?

A
  • Name and dose (in ml)
  • Batch number and expiry date
  • Site of injection
  • Any adverse side effects
  • Evidence of positive aspiration
26
Q

What is the gold standard local anaesthetic?

A

Lidocaine hydrochloride 2% and adrenaline (1:80000)

  • 20 mg lidocaine per ml
  • 12.5 ug adrenaline per ml
  • Brand name: Xylocaine 2%
27
Q

Which lidocaine LA is latex free?

A

Lignospan special 2% with adrenaline 1:80000

  • 20 mg lidocaine per ml
  • 12.5 ug adrenaline per ml
28
Q

Which adrenaline-free LA is most commonly used?

A

Prilocaine hydrochloride with felypressin

  • Trade name Citanest 3% with octapressin (Dentsply)
  • Prilocaine 30 mg per ml
  • Felypressin 0.03 IU per ml
29
Q

What is Articaine?

A

Articaine hydrochloride 4% with adrenaline 1:100000

  • Trade name Septanest 1:100000
  • Only used for local infiltrations
  • Articaine 40 mg per ml
  • Adrenaline 18.2 ug per ml
  • Not suitable for patients on beta blockers, vasopressins or cardiac glycosides
30
Q

What is Mepivicaine hydrochloride?

A

Scandonest 3% plain

  • Mepivicaine 30 mg per ml
  • Vasoconstrictor free
  • Suitable for patients for whom a vasoconstrictor is contra-indicated

BDS 2: Preparing for Patients (6 decks)

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