This document discusses complications that can arise from regional anesthesia. It begins by defining an anesthetic complication and classifying complications as either local or systemic, and mild/severe or transient/permanent. Local complications can be attributed to the anesthetic solution or needle insertion and include issues like infection, tissue reaction, or hematoma. Systemic complications involve toxicity or allergic reaction. Prevention focuses on proper technique, like slow injection rates. Management of specific issues like trismus or nerve injury is also outlined. The conclusion emphasizes the importance of careful technique and minimal necessary doses to avoid complications.

1. GOOD
MORNING
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3.  Definition
 Classification
 Local complications
 Systemic complications
 Conclusion
 References
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4.  An “Anesthetic complication” is defined
as any deviation from the normally
expected pattern during or after the
securing of regional analgesia.
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5. Primary or secondary Mild or severe Transient or permanent
Attributed to solution use Attributed to insertion of needle
Local Systemic Local
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6. Attributed to solution use
 Toxicity
 Idiosyncrasy
 Allergy
 Anaphylactic reaction
 Infection caused by contaminated solution
 Local irritation or tissue reaction
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7. Attributed to insertion of needle
 Trismus
 Hematoma
 Facial palsy
 Pain or hyperalgesia
 Broken needle
 Prolonged anesthesia
 Edema
 Infection
 Sloughing

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9.  Rare –Pogrel (1983-2008 )-16 cases
 Causes
 Intentional bending
 Forceful contact with bone
 Unexpected movements
 Management-
 locating –panaromic /ct scan
 Surgical retrieval
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10.  PREVENTION
 Do not use short needles
 Do not use 30 gauge needles
 Do not bend needles
 Do not insert to its hub
 Extra caution – child ,phobic patients
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11.  A patient’s clinical response to this can be
 Sensation of numbness
 Swelling
 Tingling
 Itching
 Associated oral dysfunction
 Tongue bite
 Drooling
 Loss of taste
 Speech impediment
Causes-
Trauma to nerve
Neurolytic agents (alcohol, phenol)
Intraneural injection
Hemorrhage
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12.  Prevention
 Careful injection technique
 Unavoidable at times
 Management
 Patient counseling and reassurance
 Documentation
 Follow-up
 ‘ tincture of time’ is the recommended medicine
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13.  Cause
 LA- parotid capsule
 Problem
 Loss of motor function
 Lopsided face
 Protective lid reflex of eye lost
 Prevention
 Protocol
 Posterior deflection –during IANB
 Varizani Akinosi not >25 mm
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14.  Management
 Reassure the patient
 Remove contact lenses
 Eye patch
 Record
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15.  Prolonged tetanic spasm of jaw muscles by which normal opening of the
mouth is restricted
 Causes
 Trauma
 Myotoxic –necrosis
 Haemorrage
 Infection
 Excessive volume
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16.  Prevention
 Sharp,sterile needles
 Proper care and handling of cartridges
 Aseptic technique and clean injection site
 Atraumatic insertion
 Minimal injections and volume
 Mangement
 Hinton –onset 1 to 6 days
 Heat therapy
 warm saline rinses
 analgesics
 muscle relaxants
 Mouth opening exercise
 Ultrasound
 Surgical intervention
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17.  Soft tissue anaesthesia > pulpal anaesthesia
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18.  Prevention
 Cotton roll - discharge
 Self adherent warning sticker
 Management
 Analgesics and antibiotics
 Saline rinses
 Petroleum jelly
 Antiseptic & analgesic gel
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19.  Effusion of blood into extravascular spaces by inadvertent nicking of a
blood vessel .
 Prevention
 Care with needle placement
 Minimize injections
 Don't probe with needle
 Modify technique
1. Short needles
2. Penetration depth
“Hematoma is not always preventable”
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20. Management
Immediate Subsequent
Direct pressure
applied at the site of bleeding
Blood vessels lies between skin and bone,
On which pressure should be applied
for not less than 2 minutes
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Ice application

21. Management
Immediate
Subsequent
Discharge once bleeding stops
Inform patient –
Soreness
Trismus
Discoloration
Analgesics
Do not apply heat for
atleast 4 to 6 hours
Heat is applied
to the region the next day
Time is the most important element
Hematoma resolves within 7 to 14 days
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22.  Causes
 Careless technique
 Dull needles
 Rapid deposit of solution
 Needles with barbs
 Prevention
 Careful technique
 Sharp needles
 Topical anesthetic
 Slow injections
 Room temperature solutions
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23.  Causes
 pH of solution
 6.5 plain & 3.5 (vasopressor)
 Wahl et al –bupivacaine with epinephrine (1:200000) > prilocaine plain
 Rapid injection
 Contamination
 Warmed solutions
 Problem
 Postanesthetic trismus ,edema
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24.  Prevention
 Slowing the injection rate at 1ml/min
not exceed the recommended rate of 1.8ml/min
 Anesthetic solution should be stored at room temperature.
 Buffering to ph 7.4
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25.  Causes
 Contamination of needle.
 Improper handling – equipment
 Improper tissue preparation.
 Injecting in to area of infection .
 Prevention
 Sterile needles
 Avoid multiple injection
 Topical antiseptic – tissue preparation
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26.  Management
 Immediate
 Incision and drainage
 Trismus – heat and analgesic , muscle relaxant
 Subsequent
 Antibiotics
a) 7-10 days
b) Penicillin v
c) 500gm immediate , 250mg qid
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27.  Causes
 Trauma
 Infection
 Allergy –angioedema
 Haemorrhage
 Irritating solution
 Problem
 Airway obstruction
 Pain
 Prevention
 Proper handling
 Atraumatic injections
 Medical evaluation
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28.  Management
 Antibiotics & analgesics
 Oral histamine blocker
 Breathing is compromised
 Position
 A-B-C-D
 Epinephrine -0.3 mg (0.3 ml of 1:1000 solution )
 I.M or I.V. histamine blocker
 Corticosteroids
 Cricothyrotomy
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29.  Epithelial desquamation & sterile abscess
 Causes
 Topical anesthetic –sensitivity
 LA with vasoconstictor
 Prevention
 Topical -1 or 2 min
 Do not use overconcentrated -
Nor epinephrine -1:30,000
 Management
 Analgesics
 Orabase –topical
 Resolve in 7-10 days
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30.  Recurrent apthous stomatitis –buccal vestibule fig 1
 Herpes simplex –extraorally ,hard palate fig 2
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Fig 1 Fig 2

31.  Viscous lidocaine –pain
 Diphenhydramine & milk of magnesia rinse
 Orabase
 Zilactin
 Resolve in 7-10 days
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33.  All drugs produce multiple effects:
These effects are categorized as:
Desired
OR
Undesired
 General Principles
 No drug exerts a single action
 No drug is non-toxic
 Potential toxicity is user dependent
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34.  Overdose reaction
 Allergy
 Idiosyncrasy
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35. Overdose Allergic Reactions
Dose related Not dose related
Systemic distribution May be systemic or localized
Extension of pharmacologic effects Unrelated to pharmacological effects
Selective CNS or CVS depression Exaggerated immune system
response
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36.  Patient factors
 Age
 Weight
 Sex
 Medications
 Disease
 Genetics
 Psychological attitude
•Drug factors
 Vasoactivity
 Concentration
 Dose
 Route of administration
 Rate of injection
 Vascularity of site
 Vasoconstrictors
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38.  Total dose is too large
 Absorption is too rapid
 Intravascular injection
 Bio transformed too slowly
 Eliminated too slowly
Intravascular injection
Occurrence varies with type of injection:
Nerve Block % positive aspirate
Inf. alveolar 11.7
Mental/Incisive 5.7
Post. sup. alv. 3.1
Ant. sup. alv./ Buccal < 1
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39.  Use aspirating syringe
 Use needle - 25 gauge or larger
 Aspirate in 2 planes
 Inject slowly
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40.  Mild Reaction -slow
onset
 Reassure patient
 Administer O2
 Monitor vital signs
 Consider IV anticonvulsant
 Allow recovery or get medical
help
 Get medical consultation, esp. if
possibility of metabolic or renal
dysfunction
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41.  Severe Reaction - rapid onset
 Stop all treatment
 Place patient in supine position, feet up
 Establish airway, give O2 (BLS)
 If convulsions, protect patient
 Summon emergency medical help
 Consider anticonvulsant drugs, vasopressors
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43.  Esters - usually to the Para-amino-benzoic-acid product
 Na bisulfite or metabisulfite - found in anesthetics as preservative for
vasoconstrictors
 Latex stopper or plunger
 Methylparaben - no longer used as preservative in dental cartridges
Allergy - signs/symptoms
Dermatologic:
Urticaria - wheals, pruritis
Angioedema
Minor rash
Respiratory:
 Laryngeal edema
 Bronchospasm
 Dyspnea
 Cyanosis or flushing
 Wheezing
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44.  Dermatologic:
 Urticaria - wheals, pruritis
 Angioedema
 Minor rash
 Typical progression
 Skin reactions
 Smooth muscle spasms (GI, GU, respiratory)
 Respiratory distress
 Cardiovascular collapse
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45.  Skin
a) Delayed –
 Benadryl –cap. 50 mg stat & Q6H x 3-4 days
 Medical consultation
 One hour stay
b) Immediate –
 Benadryl - 50 mg IM,IV stat
 Vital signs – 5min for 1 hr
 Activate EMS
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46.  Respiratory (bronchospasm )
 Oxygen
 IM epinephrine
 EMS
 On recovery -50 mg im diphenhydramine
 Cricothyrotomy
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47.  Anaphylaxis
 Place supine, on flat surface
 CABs of CPR, call for medical help
 Epinephrine 0.3 mg IV or IM (Q 5 mins)
 O2 - 6 L/min, monitor vital signs
 After clinical improvement,
 Benadryl and Hydrocortisone
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48.  How to avoid complications
 Be careful
 Know the medical history of the patient (diseases,
medications, allergy)
 Know the anatomy
 Right technique and instruments
 Aspirate
 Do not inject against hard pressure
 Inject slowly
 Use the minimum necessary doses of anaesthetic
 Use sedatives if necessary
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49.  Monheim’s local anesthesia and pain control in dental practice seventh edition
 Handbook of local anesthesia ,Stanley F. Malamed 6th edition
 Nor Tannlegeforen Tid 2005; 115: 48–52Johanna Säkkinen, Mia Huppunen and
Riitta Suuronen;Complications following local anaesthesia
 The Incidence of Complications Associated with Local Anesthesia in Dentistry
M. Daubliinder, MD, DDS,* R. Miller, MD,t and M. D. W. Lipp, MD, DDS,
PhDt*Clinic of Oral Surgery and tClinic of Anesthesiology, University of Mainz,
Germany:1997
 Bell’s Palsy: Diagnosis and Management JEFFREY D. TIEMSTRA, MD, and
NANDINI KHATKHATE, MD University of Illinois at Chicago College of
Medicine, Chicago, Illinois:Volume 76, Number 7 ◆ October 1, 2007
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50. THANK YOU
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