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Practical LA Flashcards

1
Q

Name the different nerve axons from highest to lowest in susceptibility to LA

A

A delta
C
A beta
A alpha

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2
Q

Describe A alpha nerve axons

A

Myelinated
Function:
Sensory - proprioception
Motor - mechanoreception

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3
Q

Describe A beta nerve axons

A

Myelinated
Function:
Sensory - mechanoreception

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4
Q

Describe A gamma nerve axons

A

Myelinated
Function:
Motor - muscle spindles

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5
Q

Describe A delta nerve axons

A

Myelinated
Function:
Sensory - mechanoreception, thermoreception, nociception and chemoreception

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6
Q

Describe C nerve axons

A

Unmyelinated
Function:
Sensory - nociception, thermoreception and chemoreception
Autonomic - postganglionic

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7
Q

What treatments require the use of LA?

A 
Extractions
Endodontic treatment
Crown prep 
Caries removal
Subgingival scaling
Restorations
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8
Q

Give examples of ester LAs

A

Cocaine
Procaine
Benzocaine

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9
Q

Give examples of Amide LAs

A 
Lignocaine/lidocaine
Prilocaine
Articaine
Mepivacaine
Bupivacaine
Ropivacaine
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10
Q

Which chemicals are often used as vasoconstrictors?

A

Adrenaline

Felypressin/Octopressin

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11
Q

Which preservatives are often used in LA?

A

Bisulphite

Propylparaben

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12
Q

Describe the properties of lignocaine

A

Lidocaine hydrochloride (2%)
Vasoconstrictor - plain (3%) or 1:80,000 adrenaline (2%)
Metabolised in the liver and plasma
Excreted by the kidneys

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13
Q

What is the onset of lignocaine?

A

Rapid - 2-3 minutes

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14
Q

What are common uses of lignocaine and prilocaine?

A

Infiltrations and blocks

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15
Q

Describe the properties of prilocaine (citanest)

A

Prilocaine hydrochloride (3%)
Vasoconstrictor - plain or felypressin/octapressin (1.2microg)
Metabolised in the liver and plasma
Excreted by the kidneys

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16
Q

Describe the properties of articaine (septanest)

A

4% articaine
Vasoconstrictor - adrenaline, 1:100,000, 1:200,000, 1:400,000
Metabolised mainly in plasma but also liver

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17
Q

What is articaine mainly used for?

A

Infiltrations

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18
Q

What are the main differences between articaine and lidocaine?

A

Articaine is more potent and has a faster onset

Articaine has a shorter fast life and is emiminated quicker

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19
Q

What is the most common topical anaesthetic and what flavours does it come in?

A

Xylonor gel

Comes in mint or bubblegum

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20
Q

What are the different types of maxilla LA injections?

A

Dental pulp - buccal infiltration
Buccal gingivae - buccal infiltration
Palatal gingivae - palatal infiltration

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21
Q

What injections are used for the lower molars and second premolar?

A

Dental pulp - IAN block

Buccal gingivae - buccal infiltration

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22
Q

What injections are used for the lower premolars and canines?

A

Dental pulp - mental nerve block

Buccal gingivae - buccal infiltration or mental nerve block

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23
Q

What injections are used for the lower canines and incisors?

A

Dental pulp - buccal/labial infiltration
Buccal gingivae - buccal/labial infiltration
Lingual gingivae - secondary part of IAN block or lingual infiltration

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24
Q

Which nerves supply the upper teeth?

A

Anterior superior alveolar nerve (V2)
Middle superior alveolar nerve (V2)
Posterior superior alveolar nerve (V2)

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25
Which nerves supply the upper gingivae?
``` Nasopalatine nerve (V2) Anterior superior alveolar nerve (V2) Middle superior alveolar nerve (V2) Posterior superior alveolar nerve (V2) Greater palatine nerve (V2) ```
26
Which nerves supply the lower teeth?
Incisive branch of inferior alveolar nerve (V3) | Main trunk of inferior alveolar nerve (V3)
27
Which nerves supply the lower gingivae?
``` Mental nerve from inferior alveolar nerve (V3) Buccal nerve (V3) Lingual nerve (V3) ```
28
What is the difference between an infiltration and nerve block?
Infiltration blocks the terminal nerve ending | Nerve block blocks the main trunk
29
Describe a good technique for administering LA
Check patients medical history Position patient in the chair Dry the mucosa of the selected site of injection Apply a pea-sized amount of topical anaesthetic to the mucosa for 1-2 minutes Pull the mucosa tight and puncture the mucosa quickly Aspirate Drip LA solution in slowly
30
When is a posterior SAN block used?
For pulpal anaesthesia of the maxillary 6s, 7s and 8s
31
When is a middle SAN block used?
For pulpal anaesthesia of the maxillary 3s, 4s, 5s, and 6s
32
When is an anterior SAN block used?
For pulpal anaesthesia of the maxillary 1s, 2s and 3s
33
Name the important landmarks of an IAN block
Coronoid notch of the ramus Posterior border of the mandible Pterygomandibular raphe Lower premolars on the contralateral side
34
Describe good technique for an IAN block
Advance the needle until you get mandibular contact, withdraw slightly (~1mm) Aspirate and inject 2/3s of solution then withdraw (~2-4mm) Inject last 1/3 to anaesthetise the lingual nerve
35
What is the mental nerve and where does it lie
The terminal branch of the inferior alveolar nerve that comes through the mental foramen that sits between the apices of the mandibular 4s and 5s
36
What does a mental nerve block anaesthetise?
The skin in the chin and lip region as well as the buccal mucosa and the teeth from the lower 4 to the midline
37
What is an infraorbital nerve block?
Anaesthesia of the terminal branch of the maxillary division of the trigeminal nerve (CNV2) that passes through the infraorbital foramen
38
What does an infraorbital nerve block anaesthetise?
Sensation to the lateral aspect of the nose, sensation to the skin in this area as well as the maxillary incisors and canines
39
Describe a modified technique for palatal anaesthesia
Give buccal/labial infiltration first Inject into the interdental papilla next, slowly advancing the needle into the palatal portion of the interdental papilla until the palatal tissues blanch Inject into the blanched area on the palatal side
40
Why is a modified technique used for palatal anaesthesia?
More time consuming but less painful for the patient
41
What is intraligamentary anaesthesia and when is it used?
Injection of LA into the PDL Used in oral surgery due to potential damage to the PDL Often the second option
42
What is the downside to intraligamentary anaesthesia?
Usually only anaesthetises one tooth - may slightly numb the adjacent tooth
43
What is intraosseous injection and when is it used?
Use a stabident perforator and or raise a buccal flap and create a hole through the buccal plate using a small round bur Last resort but highly effective
44
What are the advantages of topical jet injectors?
Good for patients with bleeding disorders as the mucosa is not being pierced to induce bleeding Good for those that are scared of needles
45
What are the disadvantages of topical jet injectors?
Expensive Potential soft tissue damage (operator dependent) Loud sound Taste of solution poorly tolerated
46
What are the alternative techniques for an IAN block?
Gow Gates - open mouth technique | Akinosi - closed mouth technique
47
Describe the Gow Gates technique?
Patient lying flat Aim for the condylar process Needle inserted into the soft palate past the last standing molar - needle should touch the neck of the condyle
48
What is the advantage of the Gow Gates technique?
With 1 injection, it anaesthetises the IAN, lingual nerve, mylohyoid nerve and long buccal nerve
49
When is the akinosi technique used?
For patients with severe trismus who cant open their mouth - patients should be able to open further after this Used more often than Gow Gates
50
Describe the akinosi technique
Pull cheek away from teeth and insert needle parallel to the occlusal plane just above the gingival margin of the maxillary molars until the beginning of the needle starts at the level of the 7 or 8 Inject into the area between the maxilla and the ramus of the mandible
51
What is the wand?
A short, fine needle that releases LA solution at a constant pressure when the operator presses on the foot pedal
52
When is the wand used?
Most commonly in paediatrics Used in intraligamentary anaesthesia - constant pressure reduces chance of the patient experiencing pain Used for modified PDL injections where the wand tip is inserted into the PDL space, parallel to the long axis of the tooth
53
How should you check for successful anaesthesia?
Ensure patient knows they should still feel pressure, no pain In anaesthetised area, patient should feel rubbery, numb, tingly and swollen Consider probing the PDL space to see if the patient can feel it
54
What feelings should patients with IAN block experience?
Tongue and lower lip should be numb to the midline
55
In what diseases should LA dose be altered?
Liver and kidney disease
56
What are the systemic complications of LA?
Psychological Drug Interactions Allergy Toxicity
57
Give examples of psychological LA complications
Fainting, palpitations, pallor, weakness, bradycardia, nausea, pupil dilation, restlessness
58
What causes psychological LA complications?
A lack of oxygenated blood to the brain
59
How should psychological LA complications be managed?
Manage a faint by laying the patient flat, raising their legs, loosen tight clothing around the neck, improve ventilation and give the patient a sweet drink if they have not eaten
60
What drugs commonly interact with LAs?
``` MAOI’s (antidepressants) Tricyclics (antidepressants) Beta blockers Non-potassium sparing diuretics Cocaine ```
61
What should happen if a patient has a suspected LA allergy?
Very rare | Send patient for a patch test - these patients often can’t get treated in a GDP setting
62
Describe toxicity to LA and its effects
Occurs if too much LA is given | Causes circulatory collapse, respiratory depression and loss of consciousness
63
Give examples of local complications of LA
``` Failure to achieve anaesthesia Prolonged anaesthesia Pain during or after injection Trismus Blanching Nerve paralysis Broken needle infection Soft tissue damage ```
64
What is trismus and when does it often occur?
Mouth opening is severely restricted Can occur following an IAN block Result of damage to the medial pterygoid
65
What are the different treatments for trismus?
Reassurance Muscle relaxants ie - diazepam Therabite or trismus screw to physically open the jaw Anti-inflammatories ie - ibuprofen
66
Describe facial palsy
Affects the entire facial nerve on one side | Patient cant move any of the muscles on the affected side of the face
67
What causes facial palsy?
LA injection into the parotid gland, which CNVII passes through
68
How is facial palsy managed?
Reassure the patient that it is temporary and cover the eye with a patch until blinking reflex returns to prevent the eye from drying out
69
What are the differences between facial palsy and a stroke?
In a stroke, only the lower portion of the face becomes paralysed Patient can raise their eyebrows and wrinkle their forehead as the temporal branch of CNVII is spared
70
How are the branches of the facial nerve tested?
Ask the patient to close their eyes tightly, smile, raise their eyebrows, frown and puff their cheeks to determine if the issue is a facial palsy or a stroke
71
What is the maximum safe dose for lidocaine?
2% with 1:80,000 adrenaline - 5mg/kg
72
What is the maximum safe dose for prilocaine?
3% with octapressin - 8mg/kg
73
What is the maximum safe dose for articaine?
4% with 1:100,000 adrenaline - 7mg/kg

Local Anaesthetic (3 decks)

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