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Year 1 Sem 2 Local Anaesthesia > Local complications and post-operative considerations > Flashcards

Local complications and post-operative considerations Flashcards

1
Q

What are the 8 main LA complications?

A
  • Slow onset
  • Positive aspiration
  • Pain at injection site
  • Burning on injection
  • Facial nerve paralysis
  • Trismus
  • Haematoma / ecchymosis
  • Inadvertent LA spread
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2
Q

What are the 5 postoperative considerations associated with LA?

A
  • Trauma/ self inflicted injury
  • Needle stick injury
  • Needle breakage
  • Nerve damage
  • Infection
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3
Q

Describe the main LA complications of slow onset

A
  • LA deposited too far way or in the wrong site
  • Physical barriers that prevent diffusion: muscle, bone and fluid
  • pH of tissues: inflammation

Occurs when:
• You don’t wait long enough for LA to diffuse into nerve
• Given wrong concentrations
• Using higher pKa

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4
Q

Describe the management of slow onset

A
  • Deposit more local anaesthesia
  • Deposit more proximal along nerve trunk (block)
  • Supplemental infiltration: buccal or lingual
  • Using a periodontal ligament injection
  • Intrapulpal or intra-osseous
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5
Q

Describe the main LA complications of positive aspiration

A

Injecting whilst in artery will lead to rapid effect of vasoconstrictor

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6
Q

Describe the management of positive aspiration

A
  • If positive, and carpule remains relatively clear, draw back a little and reposition. Aspirate again
  • If positive, and carpule is cloudy/cannot see another potential aspirate, remove and replace. Reinject
  • Aspirate at least twice during IAN block
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7
Q

Describe the main LA complications of pain at injection site

A
  • Blunt needle. Needles remain sharp for 2-3 injections
  • Injecting into inflamed tissue
  • Infiltration = not profound effect
  • Injecting too quickly
  • Carpule too cold. Warm to at least room temperature

Using too large a needle
• No discernable difference between 27 and 30G to patient.
• Larger than 25G generally too big especially for palate

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8
Q

Describe the management of pain at injection site

A
  • Use topical
  • Inject into taut tissues
  • Insert needle in a straight path
  • Bevel parallel to bone
  • Inject SLOWLY
  • Use distraction techniques. Verbal or Physical
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9
Q

Describe the main LA complications of burning on injection

A
  • Due to pH. Local anaesthetics is acidified to lengthen shelf life
  • A solution containing a vasopressor is more acidic
  • Rapid injection (especially in more adherent tissues like the palate)
  • Contamination of the L.A. cartridge (if they are stored in alcohol or other sterilizing solutions)
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10
Q

Describe the main LA complications of facial nerve paralysis

A
  • Orbital and zygomatic branches of CN VII are blocked within deep pole of parotid gland
  • Other branches can also be affected
  • LA deposited too far posteriorly during inferior alveolar block
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11
Q

Describe the management of facial nerve paralysis

A
  • Review landmarks and technique
  • Deposit solution slowly
  • Explain that the situation is transient and will resolve
  • Keep the cornea lubricated
  • Remove contact lenses
  • Apply eye patch / tape lid shut until normal function returns
  • Prevention of dust entering, and drying out
  • Record the incident
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12
Q

Describe the main LA complications of trismus

A
  • Known as reduced or restricted opening of mouth
  • Can be caused by trauma to muscles or blood vessels, especially to medial pterygoid
  • Haemorrhage: Large volumes of blood can produce tissue irritation leading to muscle dysfunction
  • Infections
  • Too much LA deposited into an area (post injection)
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13
Q

Describe the management of trismus

A
  • NSAIDs and gentle jaw exercises
  • Heat packs for 20 mins/ hr
  • If the patient reports difficulty opening their month (after 1-6 days post treatment) , arrange an appointment
  • Warm saline rinses (Hold in mouth for a while and spit out)
  • Muscle relaxants
  • Physiotherapy
  • If trismus occurs 2-3 days after injection, get it checked: antibioitics
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14
Q

Describe the main LA complication of haematoma/ ecchymosis

A
  • Needle trauma to vessels can cause bleeding into tissues. This can sometimes compromise the airway
  • Can result in trismus
  • Arterial bleed will cause a rapid swelling
  • Severity: Occasionally a small ecchymosis appears at puncture site
  • Swelling and discolouration usually subside within 7-14 days
  • Haematomas can become infected
  • PSA or IAN blocks can result in hematomas
  • Can occur when you advance a needle through a canal
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15
Q

Describe the management of haematoma/ ecchymosis

A
  • Know if your patient has a bleeding disorder
  • Knowledge of anatomy
  • Local infiltration instead of block
  • Minimise the number of needle penetrations
  • ASPIRATE

Managing a haematoma
• Apply firm pressure immediately to limit size of bleeding
• Apply ice externally (constricts vessels)
• Avoid heat packs initially (vasodilation),
• Advice of possible soreness and trismus (aspirin, NSAIDs)
• Discolouration (bruising) can last 2-3 weeks
• Heat may later serve as an analgesic and muscle relaxant
• The haematoma will disperse in 7-14 days

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16
Q

Describe the main LA complication of inadvertent LA spread

A
  • Spread of LA solution to other spaces or along fascial planes
  • Inferior alveolar block: Can spread throughout infratemporal fossa likee auriculotemporal nerve anaesthesia or Long buccal nerve
  • If in parotid gland then you get facial nerve anaesthesia
  • Posterior superior alveolar nerve block: to pterygopalatine fossa
17
Q

Describe the post- operative consideration of trauma/ self inflicted injury

A
  • Self inflicted injury to soft tissue may occur in some population groups: children and disabled, or even curious patients
  • Leads to swelling and significant pain when the anaesthetic wears off
18
Q

Describe the management of trauma/ self inflicted injury

A
  • Use an appropriate duration L.A
  • Warn the patient against eating, drinking hot fluids, biting for test
  • Place a cotton roll between the lips and teeth secured with dental floss around the teeth
  • Self adherent warning sticker
19
Q

Describe the management of a needle stick injury

A
  • Follow correct sharps handling
  • Never retract oral tissues with your finger
  • Watch out for assistants’ fingers as well!
  • Beware of orthodontic appliances
Management: 
• Stop what you are doing
• Squeeze and irrigate with disinfectant
• Dry, apply antiseptic ointment 
• Report the injury
20
Q

Describe the post operative consideration of a needle breakage

A
  • Extremely rare
  • Due to a sudden unexpected movement as the needle penetrates muscle or periosteum
  • Breakage happens at the hub
21
Q

Describe the management of a needle breakage

A
  • Don’t insert all the way in: avoid short needles for block anaesthesia
  • Don’t bend the needle
  • Smaller gauge needles (30 gauge) are more likely to break than the larger needles (27 gauge)

Management
• If visible: Remove it: grasp the fragment with haemostats or artery forceps
• If not visible: Refer to appropriate surgeon for removal
• Antibiotics, analgesic if necessary

22
Q

Describe the post operative consideration of nerve damage

A

Physical injury:
• Needle trauma
• Advancing needle in a foramen or canal will increase the risk- mental block
• Haemorrhage into or around the neural sheath. Bleeding increases pressure on the nerve

23
Q

Describe the management of a nerve damage

A
  • Follow up and ongoing monitoring (referral would be wise)
  • Contact professional dental body / indemnity insurance for advice

Documentation:
• History
• Subjective appraisal: descriptors (burning, pins and needles etc, depth)
• Objective neurosensory testing

  • Most paraesthesia’s resolve, to some degree, within 6-8 weeks without treatment
  • Recovery can take up to 1 year
  • Provide ongoing review appointments, especially early on
24
Q

Describe the post operative consideration of infection

A
  • Contamination of the needle before administration
  • Injection into an area of infection (L.A. is less effective)
  • L.A. under pressure (periodontal ligament injection) might transport bacteria into adjacent tissues spreading infection
25
Q

Describe the management of infection

A
  • Immediate treatment as with trismus (heat, analgesics needed, physiotherapy)
  • If signs of trismus and patient do not begin to respond within 3 days, begin antibiotics

Year 1 Sem 2 Local Anaesthesia (15 decks)

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