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Techniques for Local Anesthesia for the head and

neck

Pain Control
Techniques for Local Anesthesia for the
head and neck
Turki Alkhallagi
Mohammad Basabreen
Wejdan Asiri
Asmaa Bukhari
Sumayah Halabi
Eshrag Al-Shangiti

2009

Techniques for the Local Anesthesia


C T. 1 6 - 2 3 \ 1 0
for Othe
head & neck

Mohmaim Local Anesthesia << reference book


First Slide\ Incomplete
Pain Pathway: impulse:
Threshold: stimulus impulse 3 neurons
Methods of Pain control:

Local Anesthesia: case of insensibility of a region

if we had pained tooth: cortex pain perception

Blocking the Pathway of impulses:

Decortication ( desensiting of the pain to cortex)


Patient is generally anesthetized
Stimulus impulse (stop) X brain X

Kinds or Types of local Anesthesia Techniques:


i.
ii.

Topical (surface) anesthesia


Injectable:
1) Infiltration : soft tissues, hard tissues
2) Block anesthesia

Topical Anesthesia:
Paste, volatile liquid, solution, lozenge, mouthwash;
skin, mucous membranes & renders the area insensible.

Technique: penetrate through epithelium of the

Penetrate till it reaches nerve filaments.


Uses:
I&D (incision & draining)
Taking impression for gagging patients
Before needle insertion
Bronchoscopy, Ophthalmic A.

Soft Tissues Infiltration Anesthesia:

Submucous
Subperiosteal
Paraperiosteal
Periodontal (Intraligamental)
Papillary
Field (ring) block
Jet injection
Intrapulpal

Bony Tissue Infiltration:

iii.

Intraseptal: during bone surgery


IN soft bone
Intra-osseous: if N.B is not applicable (thick needle bone nerve)

Nerve Block: Depositing solution in close proximity to a nerve trunk

Choice of L.A. (Factors Influencing Selection): << ESSAY

1) Area to be anesthetized:
Maxilla + Mandibular anterior region infiltration
Mandibular posterior region nerve block
2) Extent of surgical Procedure:
Single extraction Infiltration
Multiple extractions, large amount of solution, several punctures, large area N.B.
3) Duration & profoundness of anesthesia required:
Larger time + prof. anesthesia N.B.
Otherwise infiltration
4) Age of patient
Older: dense bone N.B.
Younger: less dense bone infiltration
5) Hemostasis if needed:
If needed infiltration
If not N.B.
6) Presence of presence of infection:
Inflamed area N.B.
No infection infiltration
7) Skill of operator.

Management of Patient Receiving L.A. :


Don't operate on strange patients

a)
b)
c)
d)

Preanesesthetic evaluation : History


Preanesesthetic preparation
Injection technique
Management of complication

A. Preanesesthetic evaluation:

History .. (How?) Two questions.


Advantages:
o Good diagnosis
o Evaluate general condition
o Establishing patient-doctor relationship
o Informing the patient about the procedure
o For clinical exam
Value: grouping the patients:
o Patients contraindicated to L.A.:
Allergic to L.A.
Uncontrollable
Trismus
Major operation
o Patients need medical consultation:
Cardiac

Pregnant
Diabetic
thyrotoxic
o Patients fit.

B. Preanesesthetic preparation:

Syringe
Capsule
Operator hands
Patients mouth (scaling)
Site of injection

Painless needle injection: factors or precautions: << ESSAY


Patient should be aware that he is going to have injection, but not exactly when..
Site of injection should be stretched as possible
Pressure on the site of injection (in palate)
Site should contain no air
Bevel of the needle is toward the bone
Needle prick should as fast as possible
Avoid redirection of the needle inside the tissue
Avoid forcing the needle against resistance
Aspirate before injection
Rate of injection: not more than 2ml/min
Use of sharp needles. Avoid use of contaminated needles
Watch the patient carefully to save guard against complications
Use sharp bevel, sterile (or disposable better- ) [antiseptic irritant to tissues ]

C. Injection Technique:
For a maximum effect. The injected L.A. must come into
contact at least 8-10 mm. of the nerve to block 2,3 nodes of
Ranvier.

Paraperiosteal infiltration A.:

Indication:
Max. teeth (long buccal & cutaneous coli)
Lower ant. Teeth
Method:
Max. - Buccal side\
Retraction of lip & cheek till it makes right angle with alveolar mucosa. Bevel the
needle 45 degree to the floor & insert it while holding as pin grasp in the
intersection of the mucobuccal fold (vesibulo-sulcus)and the dissecting line of the
tooth which will be the level of the apices of the upper teeth. Insert the needle
about 2mm till it touches the bone.

This will Anesthetizes the pulp, periodontal ligament, buccal and palatal cortical
bone, and buccal mucoperiostium
1.6 of the carpule
Tooth
CentralsCani
ne
Premolar

Labial innervation
Ant. Sup. Alveolar n.

Palatal innervation
Nasopalatine

Middle Sup. Alveolar n.

Molars

Post. Sup. Alveolar n.

Greater palatine or ant.


palatine
Greater palatine or ant.
palatine

Max, - palatal side\


Mid way between the med line of the palate and scalloping gingival is the line of
intersection with the dissecting line of the tooth -45 degree (=perpendicular to the
volt of palate)
Insert the needle 1.5mm labially & 0.3 palatally till it touched the bone (no more to
avoid sloughing, necrosis & pain)
Block greater palatine nerve from ptrygopalatine ganglion it gave the palate 0.2 of
the carpule

Technique:
o Using one inch 27 gauge needle
o 5 min for maximum anesthesia
o 45 min duration
o Avoid ballooning the area, - slow
injection

The infraorbital Injection:


Ant. & middle superior alveolar N.B. << infraorbital foramina
1) The intraoral approach:
a) Bicuspid approach
b) Central incisor approach
c) Approach for edentulous ridge
Method:
Localization of the infraorbital notch
Put your thumb on the notch below the orbit in the line between middle & mesial thirds of the
orbit

N.B.\

general anesthesia work on the cortex of brain


local anesthesia work in the pain pathway (block the way of
impulse)

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