Regional anaesthesia of the head + neck

Question 1

Indications

Answer 1

Anaesthesia of the teeth for dental pain

Anaesthesia of soft tissues of face

Question 2

Contraindications

Answer 2

lack of pt cooperation
inability to perform the procedure without passing through an infected area
anticoagulant pts (warfarin)

Question 3

Complications

Answer 3

LA toxicity if maximum amounts are exceeded
failure to obtain anaesthesia 
allergy 
infection extending to deep spaces of head + neck because of injecting through an infected area
hematoma 
failure to aspirate blood
intravascular injection of epinephrine
needle breakage (rare)
needle stick of the operator

Question 4

Side effects

Answer 4

all LA stimulate the central nervous system + can produce anxiety, restlessness + tremors in sufficient doses

• dizziness
• headaches
• blurred vision
• twitching muscles
• continuing numbness, weakness or pins + needles

Question 5

Contraindications

Answer 5

presence of infection over site of injection can lead to the infection being spread through the blood stream

• if there is inflammation there may not be adequate anaesthesia + the vasoconstrictor may interfere with inflammatory process.
• pus is acidic + therefore anaesthetic may not be effective

Question 6

Bleeding disorders

Answer 6

Haemophiliacs
Pts receiving anticoagulant therapy for cardio vascular conditions
severe liver dysfunction
all may suffer extensive internal bleeding following capillary damage from injections

Question 7

Steroid therapy

Answer 7

the stress of dental trt including LA administration may cause pt to go into shock (may include those treated for Rhematoid arthritis, allergic reactions, skin complaints + eye diseases) the steroid has an effect on adrenal gland + lasts sometime after ceasing the drug

Question 8

Steroid therapy

Answer 8

they may need an additional dose of the drug to cope with the situation, their GP should be consulted
Drug interactions: Tricyclic + tetracyclic antidepressants will increase the effects of adrenaline therefore it is safer to use felypressin

Question 9

Hypertension + cardio vascular disease

Answer 9

although adrenaline may affect these it is felt that there is little risk if there is no more than 0.2mg adrenaline used in a single dental visit. However, some clinicians prefer to take precautions + will use non adrenaline LA for this group of pts

Question 10

Pregnancy

Answer 10

anaesthetics with adrenaline can be used however those with felypressin should be avoided
routine dental trt should be carried out in second trimester to avoid complications as they are least likely to occur at this stage