LOCAL ANESTHESIA ITS TYPES/ CLASSIFICATION/ MECHANISM OF ACTION USES, PHARACOKINETICS AND TECHNIQUE
Download as PPTX, PDF0 likes51 views
The document details the classification and pharmacology of local anesthetics, categorizing them into esters, amides, and quinoline groups. It outlines injection techniques for maxillary and mandibular anesthesia, including specific nerve blocks like the posterior superior alveolar and inferior alveolar nerve blocks, with instructions on injection depth, angle, and dosages. Additionally, it addresses the use of vasoconstrictors and provides guidelines for maximizing dosage based on patient health factors.
LOCAL ANESTHESIA ITS TYPES/ CLASSIFICATION/ MECHANISM OF ACTION USES, PHARACOKINETICS AND TECHNIQUE
- 2. Classification Ester group 1. Benzoic acid esters cocaine benzocaine butacaine 2. Para-aminobenzoic acid esters procaine tetracaine propoxycaine 2- chloroprocaine
- 3. Classification Amide group 1. Bupivacaine 2. Etidocaine 3. Lidocaine 4. Mepivacaine 5. Prilocaine 6. Dibucaine 7. Articaine Quinoline 1. Centbucridine
- 4. Pharmacology of commonly used LA’s Anesthetic pKa Onset Duration (with Epinephrine) in minutes Max Dose (with Epinephrine) Procaine 9.1 Slow 45 - 90 8mg/kg – 10mg/kg Lidocaine 7.9 Rapid 120 - 240 4.4mg/kg – 7mg/kg Bupivacaine 8.1 Slow 4 hours – 8 hours 2.5mg/kg – 3mg/kg Prilocaine 7.9 Medium 90 - 360 5mg/kg – 7.5mg/kg Articaine 7.8 Rapid 140 - 270 4.0mg/kg – 7mg/kg
- 5. Vasoconstrictors Concentration 1:50,000 1:80,000 1:100,000 epinephrine nor- epinephrine Minimum doses in following : • Diabetic • Cardiac • Hypertensive Catacholamines
- 6. Vasoconstrictors Concentration 1:10,000 Neosynephrine Felypressin Concentration • 0.03 I.U./ml Levonordefrin Concentration • 1:2500
- 7. Calculating Max Dose for Vasoconstrictors • 1 cartridge = 1.8cc • 1:80,000=.0125mg/cc • 0.0125 X 1.8cc= 0.0225mg • 0.04/0.0225=1.77 cartridges Max dose of vasoconstrictors • Healthy patient approximately 0.4mg • Patient with significant cardiovascular history: 0.04mg
- 8. The Carpule ( Cartridge )
- 9. Basic Injection technique 1. Sterilized sharp needle 2. Check flow of anaesthetic solution 3. Use cartridge at room temperature ≈ 220 C 4. Position patient in Supine position 5. Dry the tissue 6. Apply topical antiseptic (Optional) 7. Apply topical anaesthetic 8. Commmunicate with the patient and explain 9. Establish a firm hand rest
- 10. Basic Injection technique 10. Make the tissue taut 11. Keep the syringe out of patients’ line of sight 12. Insert the needle in mucosa 13. Watch & Communicate with the patient 14. Inject several drops of anaesthetic solution 15. Slowly advance the needle towards target 16. Deposit several drops before touching periosteum
- 11. Basic Injection technique 17. Aspirate 18. Slowly deposit the local anaesthetic solution @ 1ml/min 19. Communicate with the patient 20. Slowly withdraw the syringe 21. Observe the patient 22. Record the injection on patients’ chart
- 12. Maxillary anesthesia • 3 major types of injections can be performed in the maxilla for pain control – Local infiltration – Field block – Nerve block
- 13. Infiltration Able to be performed in the maxilla due to the thin cortical nature of the bone Involves injecting to tissue immediately around surgical site Supraperiosteal injections Intraseptal injections Periodontal ligament injections
- 14. Field blocks Local anesthetic deposited near a larger terminal branch of a nerve - Periapical injections
- 15. Nerve blocks – Local anesthetic deposited near main nerve trunk and is usually distant from operative site -Posterior superior alveolar -Infraorbital -Middle superior alveolar -Greater palatine -Anterior superior alveolar -Nasopalatine
- 16. Posterior superior alveolar nerve block To anesthetize the pulpal tissue, corresponding alveolar bone, and buccal gingival tissue to the maxillary 1st ,2nd and 3rd molars.
- 17. Posterior superior alveolar nerve block Technique • Area of insertion- height of mucobuccal fold Above maxillary 2nd molar • Angle at 45° superiorly,medially and backwards • No resistance should be felt (if bony contact angle is too medial, reposition laterally) • Insert about 15-20mm (16mm) • Aspirate then inject if negative 0.9-1.8 ml
- 18. Middle superior alveolar nerve block Used to anesthetize the maxillary premolars, corresponding alveolus, and buccal gingival tissue Present in about 28% of the population Used if the infraorbital block fails to anesthetize premolars
- 19. Middle superior alveolar nerve block – Technique: • Area of insertion is height of mucobuccal fold in area of 1st /2nd premolars • Insert around 10-15mm • Inject around 0.9-1.2cc
- 20. Anterior superior alveolar nerve block : Used to anesthetize the maxillary canine, lateral incisor, central incisor, alveolus, and buccal gingiva
- 21. Anterior superior alveolar nerve block Technique: • Area of insertion is height of mucobuccal fold in area of lateral incisor and canine • Insert around 10-15mm • Inject around 0.9-1.2cc
- 22. Infraorbital nerve block – Used to anesthetize the maxillary 1st and 2nd premolars, canine, lateral incisor, central incisor, corresponding alveolar bone, and buccal gingiva – Combines MSA and ASA blocks – Will also cause anesthesia to the lower eyelid, lateral aspect of nasal skin tissue, and skin of infraorbital region
- 23. Infraorbital nerve block : – Technique: • Palpate infraorbital foramen extra extra-orally and place thumb or index finger on region • Retract the upper lip and buccal mucosa • Area of insertion is the mucobuccal fold of the 1st premolar/canine area • Contact bone in infraorbital region • Inject 0.9-1.2cc of local anesthetic
- 24. Greater palatine nerve block Can be used to anesthetize the palatal soft tissue of the teeth posterior to the maxillary canine and corresponding alveolus/hard palate
- 25. Greater palatine nerve block – Technique: • Area of insertion is ~1cm medial from 1st st/2nd maxillary molar on the hard palate • Palpate with needle to find greater palatine foramen • Depth is usually less than 10mm • Utilize pressure with elevator/mirror handle to desensitize region at time of injection • Inject 0.3-0.5cc of local anesthetic
- 26. Nasopalatine nerve block Can be used to anesthetize the soft and hard tissue of the maxillary anterior palate from canine to canine
- 27. Nasopalatine nerve block Technique: • Area of insertion is incisive papilla into incisive foramen • Depth of penetration is less than 10mm • Inject 0.3-0.5cc of local anesthetic • Can use pressure over area at time of injection to decrease pain
- 28. Maxillary nerve block (V2 block) Can be used to anesthetize maxillary teeth, alveolus, hard and soft tissue on the palate, gingiva, and skin of the lower eyelid, lateral aspect of nose, cheek, and upper lip skin and mucosa on side blocked
- 29. Maxillary nerve block (V2 block) Two techniques exist for blockade of V2 1. High tuberosity approach 2. Greater palatine canal approach
- 30. Maxillary nerve block (V2 block) High tuberosity approach technique: • Area of injection is height of mucobuccal fold of maxillary 2nd molar • Advance at 45° superior and medial same as in the PSA block • Insert needle ~30mm • Inject ~1.8cc of local anesthetic
- 31. Maxillary nerve block (V2 block) Greater palatine canal technique: • Area of insertion is greater palatine canal • Target area is the maxillary nerve in the pterygopalatine fossa • Perform a greater palatine block and wait 3-5 mins • Then insert needle in previous area and walk into greater palatine foramen • Insert to depth of ~30mm • Inject 1.8cc of local anesthetic
- 32. Mandibular anesthesia Infiltration techniques do not work in the adult mandible due to the dense cortical bone Nerve blocks are utilized to anesthetize the inferior alveolar, lingual, and buccal nerves Provides anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue, and skin of lower lip and medial aspect of chin on side injected
- 33. Inferior alveolar nerve block (IAN) Technique involves blocking the inferior alveolar nerve prior to entry into the mandibular lingula on the medial aspect of the mandibular ramus – Multiple techniques can be used for the IAN nerve block • IAN • Akinosi • Gow Gow-Gates
- 34. Inferior alveolar nerve block (IAN) Technique: • Area of insertion is the mucous membrane on the medial border of the mandibular ramus at the intersection of a horizontal line (height of injection) and vertical line (anteroposterior plane) • Height of injection injection- 6-10 mm above the occlusal table of the mandibular teeth • Anteroposterior plane - just lateral to the pterygomandibular raphe
- 35. Inferior alveolar nerve block (IAN) – Mouth must be open for this technique, best to utilize mouth prop – Depth of injection: 25mm – Approach area of injection from contralateral premolar region – Use the non-dominant hand to retract the buccal soft tissue (thumb in coronoid notch of mandible; index finger on posterior border of extraoral mandible)
- 36. Inferior alveolar nerve block (IAN) – Inject ~0.5 -1.0cc of local anesthetic – Continue to inject ~0.5cc on removal from injection site to anesthetize the lingual branch – Inject remaining anesthetic into coronoid notch region of the mandible in the mucous membrane distal and buccal to most distal molar to perform a long buccal nerve block
- 37. Mand Nerve Block GOW GATES Technique 1973- George Gow Gates Success rate > 95% (IAN 80-85%) Aspiration rate < 2% ( IAN 10-15%)
- 38. GOW GATES Technique Target Area- Lat Side of Condylar Neck Landmark- Intertragic Notch, Corner of mouth, Mesiolingual cusp of maxillary second molar Penetration- Distal to maxillary second or third molar Height- Mesiolingual cusp of Max 2nd molar(10-25 mm from occlusal plane) Depth- 25mm Deposit- 1.8 ml Time of Onset- 5-10 mins Bone Contact- If No Contact of Bone- DO NOT DEPOSIT Keep mouth open for 1-2 mins
- 40. Akinosi closed closed-mouth mandibular block – Useful technique for infected patients with trismus, fractured mandibles, mentally handicapped individuals, children – Provides same areas of anesthesia as the IAN nerve block
- 41. Akinosi closed closed-mouth mandibular block – Area of insertion: soft tissue overlying the medial border of the mandibular ramus directly adjacent to maxillary tuberosity – Inject to depth of 25mm – Inject ~1.0-1.5cc of local anesthetic as in the IAN – Inject remaining anesthetic in area of long buccal nerve
- 43. Mental nerve block Mental and incisive nerves are the terminal branches for the inferior alveolar nerve Provides sensory input for the lower lip skin, mucous membrane, pulpal/alveolar tissue for t premolars, canine, and incisors on side blocked
- 44. Mental nerve block Technique: • Area of injection mucobuccal fold at or anterior to the mental foramen. This lies between the mandibular premolars • Depth of injection ~ 5-6mm • Inject 0.5-1.0cc of local anesthesia