Complications with local anesthesia.
During the process of local anesthesia, a pharmacological multicomponent drug enters the human body (into the injection area and into the general bloodstream).
Some of these components are vasoconstrictors (vasoconstrictors - catecholamines: epinephrine, vasopressin, norepinephrine, mesatone), in addition to local effects, they have undesirable general effects: they increase blood pressure, blood sugar levels, and increase heart rate. Such effects are especially unfavorable for patients with coronary artery disease, arterial hypertension, diabetes mellitus, pheochromocytoma, glaucoma, etc.
Other components of local anesthetics - stabilizers and preservatives - may be a risk factor in patients with an allergic predisposition (especially with severe forms of hypersensitivity, for example, Quincke's edema).
What are the dangers of local anesthesia?
Dental treatment and prosthetics under general anesthesia often becomes the source of many questions. Is it dangerous to use anesthesia in this way? Will this affect your health? Are fillings on several teeth worth artificially induced sleep? After all, each of us has heard that any general anesthesia is not without consequences for the human body. Moreover, local anesthesia seems to have been successfully used for dental treatment for a long time. Of course, we are horrified by the forced “heroism” of the Soviet people, who treated their teeth without any pain relief at all - with the exception of removal, when a drug was used that did not always act properly. People of that era, not only general anesthesia, even local anesthesia could be considered a luxury. This, by the way, explains the “genetic” fear of the dentist even among the children of those who lived in those days.
However, now, as it seems to us, there are practically no problems - any pharmacy chain in Moscow will offer local anesthetic drugs to choose from. It will be enough just to give an injection and the doctor will effectively treat your teeth without any pain. Isn't this enough? Why use general anesthesia for dental treatment? Many people believe that local anesthesia is much less harmless than general anesthesia. However, is the notorious “freezing” so harmless and does it really have no effect on our body?
However, local anesthesia only looks harmless. In fact, novocaine is combined with the hormone adrenaline to narrow the capillaries, which provides a long-lasting anesthesia effect. Adrenaline, in turn, causes an increase in heart rate, which is quite undesirable for those who suffer from cardiac problems. Both novocaine and other drugs that are its analogues can cause allergies. Also, local anesthesia can increase blood pressure or cause vasospasm. Of course, if the patient’s heart is fine, as well as his blood pressure, local anesthesia does not threaten such a person. However, where can one find an absolutely healthy person in the current ecology?
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If the patient has problems with the heart and blood pressure, then local anesthesia is simply contraindicated. And any conscientious dentist, before using local anesthesia, will definitely ask the patient about his state of health. And, most likely, having heard complaints about hypertension or heart problems, he will recommend general anesthesia instead of “freezing,” which will cause much less harm to the body.
Contraindications to sedation
We said earlier that not all patients may be suitable for sedation, let's look again at the factors that are contraindicated for sedation.
So these factors are:
- patient's age,
- characteristics of the body, including allergic reactions to drugs that will be administered, that is, incompatibility with sedative drugs in a given patient,
- bad experience that the patient previously had during sedation, and in him it can also cause fear and, accordingly, panic attacks (that “having gone half asleep” the patient may not control himself).
Regarding bad experiences with sedation - yes, such cases are rare, but unfortunately they do occur. Naturally, these characteristics of the body and circumstances will also affect the effect of the drug itself, accordingly, this is a contraindication. For such patients, more careful preparation for sedation is recommended. Or vice versa - we work with such a patient in terms of organizing his treatment under local anesthesia. First, the psychologist communicates with the patient and prepares him. We also work with the patient: we explain that these procedures are for treatment and they are painless, that the quality of anesthetics is now quite high and some patients will not experience pain.
All work during treatment, if we are considering therapeutic treatment, is carried out under a rubber dam,
that is, the patient does not experience any fear that something might get into the oral cavity. And after the first two manipulations in consciousness under local anesthesia, he understands that dentistry has nevertheless made great strides forward, and that it is possible to be treated without sedation without feeling fear.
Conduction anesthesia
Conduction anesthesia: definition, technique, indications, complications
Conduction anesthesia of the upper limb
What is conduction anesthesia
Conduction anesthesia is one of the types of anesthesia in which nerve transmission is blocked in the area of the body where the operation is planned, which results in complete immobilization and pain relief.
Synonyms for conduction anesthesia: nerve block, peripheral anesthesia, nerve anesthesia, brainstem anesthesia, nerve block, conduction anesthesia.
Conduction anesthesia is one of the types of regional anesthesia.
How does the patient feel during conduction anesthesia?
At the site of conduction anesthesia, the patient may experience various sensations. At the moment of puncture with a needle, there is either slight discomfort or some pain, the severity of which is no more than the pain felt when taking blood from a vein for a test. When a local anesthetic is administered, feelings of heaviness, bloating, and heat may occur in the anesthetized area. If no technical difficulties arise during conduction anesthesia, then the duration of unpleasant sensations is calculated in only a few seconds.
During the operation, conduction anesthesia guarantees a complete absence of pain with a clear consciousness of the patient. If the patient feels anxious and wants to sleep, then conduction anesthesia can be combined with sedation.
How does conduction anesthesia work?
Anesthesia during conduction anesthesia is achieved due to the blockade of a nerve or group of nerves through which the pain impulse is transmitted from the source of pain (the site of surgery) to the brain, which processes this signal and gives it to us directly in the form of a sensation of pain. Depending on which nerve is blocked, anesthesia for a particular area of the body will occur.
How is conduction anesthesia performed?
Technically, conduction anesthesia is one or more injections of a local anesthetic solution into the area where the nerve required for the block is located. For regional anesthesia to work, the drug must be injected in close proximity to the nerve—a few fractions of a millimeter from it. If the local anesthetic is injected a little further than the nerve, then anesthesia will not develop, and the patient will feel pain during the operation, which will require a change in anesthesia tactics, in particular, the use of a different type of anesthesia. In the event that a local anesthetic is injected directly into the nerve itself, an anesthesia complication such as neuropathy may develop (see below).
What operations can be performed under conduction anesthesia?
Unfortunately, due to the anatomical characteristics of the human body, not every part of the body can be anesthetized using conduction anesthesia. Therefore, an approximate list of the main operations that can be anesthetized using conduction anesthesia will be as follows: operations on the upper and lower extremities, operations to remove an inguinal or femoral hernia, some operations on the genital organs, operations on the thyroid gland, operations on the carotid arteries, dental operations.
What are the complications of conduction anesthesia?
The most serious complications of conduction anesthesia include the development of neuropathy, as well as the occurrence of an adverse reaction to the local anesthetic.
An adverse reaction to a local anesthetic is manifested either by the development of an allergic reaction or a systemic reaction of the body. A systemic reaction of the body occurs when a local anesthetic solution is accidentally unintentionally introduced into a blood vessel; it can manifest itself as cardiac arrhythmia, dizziness, weakness, and loss of consciousness. An allergic reaction to a local anesthetic is extremely rare, occurring in approximately 1 in 50,000 anesthetics.
Neuropathy is damage or dysfunction of a nerve, manifested by various symptoms: a crawling sensation, numbness, pain or muscle weakness in the anatomical area where anesthesia was performed. However, you should not be upset or afraid of conduction anesthesia. The incidence of neuropathy is not that high - less than 1% of cases. In addition, in most cases, complete restoration of the damaged nerve’s functionality occurs within a few months (less often within a year). And, most importantly, the development of new technologies for conduction anesthesia has made it possible to minimize the likelihood of developing this type of complication.
What makes conduction anesthesia as safe as possible?
Conduction anesthesia is made as safe and effective as possible by using ultrasound.
Ultrasound helps to perform conduction anesthesia under visual control, and not blindly, as it was before (and sometimes still occurs in the vastness of our homeland). The use of an ultrasound machine helps to see the nerve and needle, and, therefore, allows you to inject local anesthetic into the required area.
The use of ultrasound in conduction anesthesia can minimize the risk of developing neuropathy, accidental intravascular injection of a local anesthetic and, most importantly, significantly increase the success of performing a nerve block, thus obtaining one hundred percent high-quality anesthesia.
Complications of local anesthesia and endodontic treatment
Posted by Tara Renton
Translation: Gavryushina Anna
Possible mechanism of nerve damage during local anesthesia
Nerve injury due to local anesthesia is a complex problem. Nerve damage may be physical (needle, compression due to epineural or perineural hemorrhage) or chemical (bleeding or local anesthetic components). Thus, the resulting nerve injury may be a combination of peri-, epi-, and intraneural trauma causing subsequent hemorrhage, inflammation, and scarring leading to demyelination (loss of the nerve sheath). Administration of local anesthesia can cause nerve damage in a variety of ways. The location of the nerve injury may also be important, as well as the mechanism. Factors to consider are that only 1.3–8.6% of patients experience an "electric shock" type sensation when receiving mandibular anesthesia, and 57% of patients who suffer from long-term neuropathy did not experience discomfort during the injection , so this is not a specific sign.
Injuries during mandibular anesthesia
Neuropathy
Any damage to sensory nerve tissue can cause a combination of anesthesia (numbness), paresthesia (altered sensation that is not painful), dysesthesia (altered sensation that is unpleasant/painful), and neuropathic pain. Neuropathy in the orofacial region should be taken seriously and the cause should be determined as there are some serious conditions that need to be addressed if the cause is not obvious. It is often possible to determine its origin from the anamnesis. Lack of sensation must be noted on the face so that the increase or decrease in the insensitive area can be assessed. Any patient with an expanding area of paresthesia for which there is no known cause should be referred to a specialist. Among other things, paresthesia can result from trauma, nerve damage, surgery, infections and prolonged reactions to local anesthesia, viruses, malignancies, or serious illnesses. If a dental cause is suspected, patients require re-evaluation, careful documentation, and follow-up.
Unilateral paresthesia and facial paralysis can occur when conduction anesthesia is administered in the wrong direction when the local anesthetic solution is deposited in the parotid gland. This usually occurs when the depth of penetration of a long needle is approximately half its length. This most likely occurs when the mandibular ramus expands laterally, making it difficult for the operator to “feel the bone.” Unilateral facial paralysis is reversible. It goes away within a few hours. The patient should be reassured and his eyes protected until the blink reflex is restored, as the corneal reflex is often impaired.
Neurological damage from untreated periapical infections
In endodontic practice, we often encounter patients with apical periodontitis of endodontic origin, leading to impaired sensitivity of the inferior alveolar or mental nerve. It invariably resolves with a decrease in inflammation and local swelling. A number of authors have reviewed and documented clinical cases of a neurological disorder with paresthesia and hypoesthesia of the mental nerve arising as a consequence of apical periodontitis of the second premolar and second molar of the mandible.
Motor nerve palsy due to endodontic treatment
There are reports of shortages
