Hey Guys, this presentation was used during the webinar on 1st May 2020 (Friday). A quick revision of the basics and i have shared my experiences from the government hospital and we have seen the clinical and practical aspects on the management of the local anesthesia side effects such as - Needle Prick Injury Parathesia Toxicity Needle Breakage Hematoma Syncope Allery and we have seen the latest trends in the pain control.

1. - By Dr. Jasmine Singh
EMERGENCY MANAGEMENT
OF
LOCAL ANESTHESIA
(DENTISTRY)

2. METHODS Used To Induce LA -
1. Mechanical Trauma
2. Low Tempertaure
3. Anoxia
4. Chemical Irritants
5. Alchohol and Phenol (Neurolytic Agents)
6. Chemical Agents (LA)

3. The BASIC CHEMICAL STRUCTURE of a local
anesthetic molecule consists of three parts :
1. A Lipophilic group an aromatic group, usually
an unsaturated benzene ring.
2. An Intermediate bond - a hydrocarbon
connecting chain, either an ester (-CO-) or
amide (-HNC-) linkage.
The intermediate bond determines the
classification of local anesthetic.
3. A Hydrophilic group- a tertiary amine and
proton acceptor.

4. ESTERS : (Contain single I in their name)
of benzoic acid
Butacaine
Cocaine
Benzocaine ( Ethyl aminobenzoate)
Hexylamine
Piperocaine (Exception to I rule)
Tetracaine
of para – aminobenzoic acid
Chloroprocaine
Procaine
Propoxycaine
AMIDES :
(Contain double I)
Articaine
Bupivacaine
Dibucaine
Etidocaine
Lidocaine
Mepivacaine
Prilocaine
Ropivacaine
QUINOLONE :
Centbucridine

5. How Does LA Work?
Theories –
The Acetylcholine Theory
Calcium Displacement Theory
Surface Charge (Repulsion) Theory
Membrane Expansion Theory
Specific Receptor Theory
JR
(DENTAL)

6. SPECIFIC RECEPTOR THEORY
LA work by binding
specific receptors
(on external surface
or
internal axoplasmic
surface)
sodium channel
Action is direct.
No change is made
in the properties of
the cell membrane.
LA gains access to
receptors
permeability Na
ions –
JR
(DENTAL)

7. sodium conductance
rate of eletrical depolarization
to achieve threshold potential level
development of action potential
nerve conduction is
Nerve Conduction Process:
EXCITED NERVE
Deploarization (1msec)
Threshold / Firing Threshold
(0.3msec)
Repolarization (0.7 msec)
TOTAL – 1msec

9. HISTORY

10. Natural Anesthetic Agent

11. Composition of LA
Local Anesthetic drug (lidocaine)
Sodium Chloride
Sterile Water
Vasopressor (epinephrine)
Sodium metabisulfite
Methylparaben
JR
(DENTAL)
Discarded in
BLUE
BMW
Bateriostatic
+
Allergy
+
Preservative
Antioxidant
Volume
Blocks the
nerve
conduction
Is stable and can be autoclaved, heated or
boiled without breaking down
Depth + Duration of anesthesia
Absorption of local anesthetic + Vasopressor
1mg/mL
0.1 % conc.
Make the solution isotonic with the
tissues of the body

13. Discarded
in RED
Needle and the cover
are discarded in
WHITE

15. LA in patients with
SYSTEMIC DISORDERS
Diabetes Mellitus
The action of vasoconstrictors directly opposes that of
insulin.
Epinephrine
gluconeogenesis and glycogen breakdown in the liver
hyperglycemia

16. Cardiovascular Disorders

17. COMPLICATIONS

18. 1. ALLERY
PATCH TEST
History – Medical and Dental
If, no history of getting the LA

19. SYMPTOMS
Skin rash or hives (urticaria)
Itching (pruritus)
Wheezing/breathing problems (airway
compromise)
Swelling (Edema)
Vomiting
Dizziness or light-headedness
Anaphylaxis

20. LIGNOCAINE ANAPHYLAXIS
 Give oxygen (5L/min)
Drugs in the given order :
 Adrenaline (Epinephrine) 1:1000 0.3-0.5ml
 Chlorpheniramine 10mg IV
 Hydrocortisone 100-200 mg IV or IM
 IV Fluid (Hypotension) 1L/5min
JR
(DENTAL)

21. Epipen
Anapen

22. 2. NEEDLE AGE
Must be PREVENTED
If happens,
 Stay calm
 Ask the patient not to move
 If visible , take it out. If not, no incision or probing to be done
 Take the radiograph
 Refer to the oral surgeon – CT and usually under GA
PREVENTION :
DO NOT insert the needle till the hub
DO NOT use short needles for inf alv nerve block
DO NOT bend the needles while inserting them

25. 3. HEMATOMA
Density
Hematoma
development
Eg. Palate
Density
Hematoma
Development
Eg. Infratemporal
Fossa
in the
extravascular
spaces

26. Pressure for 2 minutes on the site of bleeding
Ice can be applied
Heat (Warm moist )not untill 24 hours. And for 20 mins every
hours.
Heat acts as analgesic if applied in the starting
Analgesics can be given
7-14 days
Mention it on the patients record

27. Pallor
Perspiration
Cold Skin
Fainting
Weak Pulse
Semi-Reclined / Trendelenburg (Head Down)
position.
Aromatic spirit of ammonia
Oxygen / vasopressor drugs like epinephrine.
4. SYNCOPE
JR
(DENTAL)

28. Feeling numb / Frozen
Electric Shock (Needle contact with the nerve)
Patient Management
• 1. Reassure patient
• Practitioner should speak to the patient personally
• Explain how paresthesia occurs and expected timeframe for resolution
• Book an examination appointment with the patient
• Record incident in the dental record
• 2. Patient examination
• Discuss phenomenon of paresthesia with patient
• Explain paresthesia may take time to resolve and can take months, although rarely it may persist indefinitely
• Determine degree and extent of paresthesia patient is experiencing
• Record examination findings in the chart
• 3. Follow-up with patient
• Re-examine patient within one month, and then in 1 – 2 month intervals, or more often if appropriate, for as long as the
paresthesia persists. An improvement in the signs and symptoms, however gradual, is often a promising sign of eventual
complete resolution.
• If paresthesia persists at this first follow-up appointment, offer to refer the patient to an oral and maxillofacial surgeon or
other appropriate specialist for an assessment.
• 4. Dental Treatment
• Dental treatment may continue in other areas of the mouth
• If further treatment is required in the area of the sensory deficit, avoid injecting local anesthetic into this region – consider
alternative techniques to deliver anesthetic
5. PROLONGED ANESTHESIA
OR
PARESTHESIA

29. 6. NEEDLE PRICK INJURY
SCOOP TECHNIQUE
Wash hands with soap under running water for 10-
15 minutes.
Get the test’s done for HIV, Hepatitis.
Get yourself a tetnus injection.
Take patients record
Medicine – If required. Has a lot of side effects.
(Physician)
JR
(DENTAL)

31. 7. TOXICITY

34. LATEST TRENDS IN
PAIN CONTROL

35. Computer - Controlled
Local Anesthetic Delivery
(CCLAD)
The WAND
STA –
Single
Tooth
Anesthesia
DPS –
Dynamic
Pressure
Sensing
technology

36. Wand” has 3 components: Base
unit, Foot pedal and Disposable
Handpiece assembly
LA solution from the cartridge
passes through the microbore
tubing in the Handpiece
assembly and needle into the
target tissue.

37. Intranasal Local Anesthetic
Device
Snorting a line of cocaine is an example. (Illicit use)
Used in status epilepticus in young children (Midazolam)
Used for ENT procedures
For dental procedures – oxymetazoline (present in nasal
decongestant spray , Afrin) +ed to tetracaine
Anesthesia has shown success till 1st / 2nd premolars

38. DENTIPATCH
Contains 10-20% lignocaine for 15 mins
Not recommended in children
CVS and CNS side effects

39. Dentalvibe
is a cordless hand help device which gently
stimulates the sensory receptors at the
injection site causing the neural pain gate
to close.
Advantage : The tissue is vibrated before the
needle penetrates.
Disadvantage : Not directly attached to the
syringe and a separate unit is required so
both hands are engaged.

40. JET INJECTORS
PRINCIPLE : Mechanical Energy Source
To create a pressure sufficient enough to
push a liquid through a very small
orifice. That can penetrate
subcutaneous tissue without the needle.
CANNOT be used in nerve block.
ONLY infiltration and surface anesthesia.