Local Analgesia Flashcards

1
Q

What topical preparations of lidocaine are available ?

A

2% gel
10% spray
5% ointment

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2
Q

What topical preparations of benzocaine are available ?

A

20% gel

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3
Q

How does topical lidocaine impact total LA dose ?

A

Lidocaine is well absorbed so must be included in total dosage

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4
Q

What does topical anaesthetise ?

A

Non keratinised mucosa

2-3 mm into soft tissues

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5
Q

What doesn’t topical anaesthetise ?

A

Limited use on palatial mucosa or attached gingivae

Pain produced by rapid injection

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6
Q

What is the difference between analgesia and anaesthesia ?

A

Analgesia is absence of pain sensation

Anaesthesia is absence of all sensation

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7
Q

What skin preparations are available ?

A

Amitop and EMLA
Amitop takes 60 mins to work
EMLA takes 45 mins to work

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8
Q

Lidocaine …

A

2% and adrenaline 1:80000
2-3 mins to effect
45-60 min duration
Max dose is 4.4 mg/kg up to 300mg max

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9
Q

Prilocaine …

A
4% and felypressin 0.03IU/ml 
Less effective than lidocaine 
Used when adrenaline contraindicated 
Max dose is 6mg/kg up to 400 mg 
Latex free
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10
Q

What is the association between felypressin and scheming heart disease ?

A

Causes coronary arteries to constrict

Limit of 3 cartridges for those with ischemic heart disease

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11
Q

Mepivocaine …

A
2 or 3% with 1:100000 adrenaline 
Least vasodilation so can be used plain 
30 min duration 
Max dose is 4.4mg/kg up to 300 mg 
More effective for block than infiltration
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12
Q

Articaine vs lignocaine

A

Articaine more effective for buccal infiltration next to molars and upper lateral incisors
Safer
But causes more post injection pain

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13
Q

What anaesthetic agents can be used as topical anaesthetics ?

A

Lidocaine

Benzocaine

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14
Q

Where is infiltration anaesthesia deposited ?

A

Around nerve terminals

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15
Q

Which sized needles are used for infiltration and nerve block anaesthesia ?

A

Infiltration is 25mm

Nerve block is 35mm

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16
Q

Where is the needle placed for mental block ?

A

Between the apices of premolars

17
Q

Where is the needle placed for palatial anaesthesia ?

A

Distal to the tooth being treated
Except for incisors and premolars and third molars
Use chasing technique

18
Q

What is the target for the long buccal block ?

A

Supra periosteal distal and buccal to the last standing molar
2-4 mm depth
Can also inject in cuscus distal to tooth being treated

19
Q

What are the anatomical landmarks for the inferior alveolar nerve block injection ?

A

Thumb placed at anterior notch
Needle entry is junction of buccal pad of fat and pterygomandibular raphe
advance to bony contact there should be 1 cm needle showing
If no bony contact move the needle distally
If contact too early move mesially
For lingual anaesthesia withdraw while injecting final 1/3 of solution

20
Q

What are the contraindications to LA?

A
Bleeding diasthesis
Incomplete root formation
Susceptibility to endocarditis 
Pademaker
Epilepsy
Trismus
Cerebrovascular disease
21
Q

What are the local complications with LA?

A
Pain on injection 
Pain after injection 
Vascular problems
Failed anaesthesia 
Localised neurological problems 
Infection 
Interference with wound healing 
Self inflicted trauma 
Trismus
22
Q

What causes pain on injection ?

A
Subperiosteal injection 
Intraepithelial injection 
Too rapid injection 
Direct contact with nerve trunk 
Solution factors ph and temperature
23
Q

What causes post injection pain ?

A

Sub periosteal injection
Forceful intraligamentary injection
Muscle damage

24
Q

What causes neurological effects in relation to LA?

A

Prolonged anaesthesia due to nerve trunk damage, repeat injections, solution concentration
Facial paralysis due to injection into parotid gland
Auditory and visual disturbances

25
What vascular problems can be caused by LA?
Intravenous injection - haematoma | Intra arterial injection - localised blanching
26
What effects can LA have on would healing ?
LA decreases cell motility Adrenaline reduces oxygen tension Increased risk of dry socket with LA with adrenaline
27
What systemic effects unrelated to LA agent can occur ?
Psychogenic effects eg fainting | Infection eg hiv, hepatitis
28
What systemic effects related to LA agent can occur ?
Toxicity Methemoglobinaemia Drug interactions Allergy
29
What is methaemogloninaemia ?
Prilocaine, benzocaine and articaine metabolites convert iron in Hb to ferric state Decreases oxygen carrying capacity
30
Which drugs can interact with LA?
Procaine and prilocaine and sulphonamides can produce metheamoglonilinaemia Lidocaine prolongs suxamethonium Lidocaine and membrane stabilising agents La and beta blockers
31
Which drugs can the adrenaline in some LA s react with ?
MAOIs, TCAs, phenothiazine, beta blockers, non potassium sparing diuretics, drugs of abuse
32
What measures should be takes if a patient is having repeated system is post treatment effects ?
Check weight and dosage Check blood pressure Check anxiety
33
What are the signs of LA overdose ?
Tonic clonic seizure activity then generalised CNS depression, depressed blood pressure, heart rate and respiratory rate