update of local anesthesia

7/30/2019 Update of Local Anesthesia

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PUTRI

MAHFUZAH 160112123009

SUGANYA 160112123012MOHD AZRUL 160112123008


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Local Anasthesia:

Lidocaine

Hydrogen Chloride

Purpose (1948):

pain free treatment a pain free post

treatment period

Complains:

lingering numbness of

residual STA

inconvinient,uncomfortable, lead

to soft tissue injury

(children)


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Expected Durations of Pulpal and Soft Tissue

Anesthesia (STA)

Vasopressor Pulpal anesthesia (minutes) STA (minutes)

SHORT-DURATION

Mepivacaine hydrogen

chloride (HCl)none

20 to 30 (infiltration)

30 to 45 (nerve block)90 to 120

Prilocaine HCl None



45 to 65 (nerve block)

120 to 240 (nerve block)

INTERMEDIATE-DURATION

Articaine HCl1:100,000

1:200,000

60 (infiltration)

up to 120 (nerve block)180 to 240

Lidocaine HCl1:50,000

1:100,000



Mepivacaine HCl1:20.000 levonordefrin 40 to 60 (infiltration)


Prilocaine HCl 1:200,00035 to 45 (infiltration)


LONG-DURATION

Bupivacaine HCl 1:200,000Up to 7 hours (infiltration)

Up to 7 hours (nerve block)240 to 720

Short acting drugs:

Mepivacaine HCl 3% Prilocaine HCl 4%

Pulpal anasthesia for

30 miniutes

Fail to meet the pain

control needs

dental treatment 44

minutes

Intermediet duration drugs:

Articaine HCl 4% with epinephrine

1:100.000 and 1:200.000 lidocaine HCl 2% with epinephrine

1:50.000 and 1:100.000

Mepivacaine HCl 2% with levonordefrin

1:20.000 Prilocaine HCl 4% with epinephrine

1:200.000

Most often use for dental treatment

because it has an inclusion with vasopresor

Duration 60 minutes

Long duration drugs:

bupivacaine HCl 0.5 %

+ epinephrine 1:200.000 (nerve block)

Pulpal anasthesia for 7

hours

With STA 12 hours


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To determine a local anasthesia depends on the

treatment and the choice of LA technique:

curetagge periodontal surgery

extractions

implants

subgingival tooth preparation

Technique of LA:

infiltration

nerve blocks (inferior alveolar Gow-Gates)

intraligamentary injection new technique

intrasseous injection with minimum of

associated LA


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Residual STA

Present as inconvinience or

embarrassment to the patient, including 3major areas:

functional

sensory

perceptual

Functional :

diminished ability to speak

(lisping) to smile (asymmetric)

to drink (liquids runs out

from the mouth)

the in abillity to controldrooling while still numb

Sensory:

lack of sensation

discomfort

Perceptual:Perception that their

body was distorted

(swollen lips)unpleasant


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Residual STA

Can lead to self-inflicted injury (lip/tongue) in

any patient:

younger children

mentally disabled adult and pediatric

patients

geriatric patients with dementia greatestrisk of soft-tissue injury

Soft tissue injury


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Incidence of Lip Injury Following

Inferior Alveolar Nerve Block

Age (years) % with soft tissue injury to lip

12 7


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Phentolamine Mesylate(OraVerse)

Phentolamine Mesylate

(Oraverse)


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INTRODUCTION

Phentolamine is a non-selective competitive

alpha adrenergic receptor antagonist.

It is a short acting antagonist andantagonizes both alpha and alpha

receptors, thus blocking the actions of the

circulating catecholamine, epinephrine andnor-epinephrine.


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INTRODUCTION

Ultimate Effect of alphareceptor blockade

VASODILATION

Rapid distribution of local anesthetic solutionaway from the injection site


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METHOD

Patient receives a traditional intraoralinjection at the onset of the treatment.

At the end of the traumatic portion of the dental procedurePM injection / sham injection at the same site.

All patients were observed for 5 hours to collect efficacyand safety data and then monitored for up to 48 hours.


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First endpoint: return of normal lip sensation

from the patients response to lip palpation

Second endpoint: patients perception of

altered function, sensation and appearance,

functional deficits in smiling, speaking,

drinking and drooling.

Impact of functional deficitspatients

response (STAR questionnaire)


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Functional Assessment Battery (FAB):measurements of smiling, speaking, drooling,

drinking 3 ounces of water at various timepoints during the study.

Heft-Parker Visual Analogue Scale (H-P VAS):a 170 mm visual analog scale containing thefollowing verbal descriptors: none, faint,weak, mild, moderate, strong, intense, andmaximum possible.

*Patients were asked to place a mark on the line thatcorresponded to their current assessment of pain atthe injection site and the procedural site.


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RESULTS


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EFFICACY OF PM:

Maxillary trial: the median time to recovery of

normal sensation in the upper lip was 50 min for

PM patients and 132.5 min for sham patients, a

reduction in anesthesia of82.5 min. Mandibular trial : the median time to recovery of

normal sensation in the lower lip was 70 min for

PM patients and 155 min for sham patients, areduction in lower lip anesthesia of85 min.


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Other Findings..


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SAFETY OF PM:

Adverse effect : diarrhea, facial swelling, increasedblood pressure/hypertension, injection sitereactions, jaw pain, oral pain, paresthesia, pruritis,tenderness, upper abdominal pain, and vomiting.

* Majority of adverse reactions were mild andresolved within 48 hours.


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CLINICAL USE AND INDICATIONS:

Not recommended foruse in children under 6years or < 15 kg.

Administration basedon the number ofcartridges of LA +vasoconstrictor - in anequal volume.

Administered at thesame location andtechnique used earlierfor the LAadministration.


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update of local anesthesia

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