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BDS2: LA Symposium > Local Anaesthetic Overview Part 2 > Flashcards

Local Anaesthetic Overview Part 2 Flashcards

1
Q

What are advantages of safety syringes?

What are disadvantages?

A
  1. Single use
  2. Sterile until opened
  3. Lightweight

Disadvantages:

  1. Requires additional training
  2. May feel awkward to first time user
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2
Q

What name is given to the first part of the needle that enters the patient?

A

Bevel

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3
Q

What is the most fragile part of the needle?

A

The hub

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4
Q

What is the function of the bevel?

A
  1. Defines the point or tip of the needle, providing cutting surface to penetrate the mucosa with as little resistance as possible
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5
Q

How does the angle of the bevel affect the passage of the needle through tissue?

A

> angle of bevel with long axis of needle > will be the deflection as the needle passes through tissue

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6
Q

What does the gauge number represent?

A

The diameter of the lumen of the needle

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7
Q

How does the gauge number relate to the needle diameter?

A

greater gauge = smaller diameter

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8
Q

What are the advantages of a gauge needle?

A
  1. Gauge needles result in less deflection as they pass through tissues which results in greater accuracy
  2. Gauge reduces risk of breakage
  3. Gauge results in easier aspiration
    - resistance to flow is greater for smaller gauges needles
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9
Q

What length do short/long needles measure from hub to tip?

What are the different lengths used for?

A

Short - 20-25mm
- used for infiltration

Long - 30-35mm
- used for inferior alveolar nerve block

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10
Q

List the 5 components of an LA cartridge

A
  1. Cylindrical glass tube
  2. Stopper (plunger bung)
  3. Aluminium
  4. Diaphragm
  5. Solution (2.2ml)
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11
Q

Describe the equipment you would need to gather for a LA injection

A

1.syringe handle and bung

  1. Syringe barrel
    - short 25mm for infiltration
    - long 35mm for inferior alveolar nerve block
  2. Cartridge

Note: check expiry date and batch

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12
Q

What are the 3 LA used in clinic and what are the colour codes?

A
  1. Lignocaine
    - blue
  2. Articaine
    - gold
  3. Citanest
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13
Q

What are the components of a syringe handle?

How are these put together?

A
  1. Finger rest
    - slides onto thumb ring
  2. Thumb ring
  3. Rubber ring
    - attaches to bottom of the thumb ring with the BROADER END FACING TOWARDS THE TOP
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14
Q

How do you prepare your safety syringe needle for use

A

Pull back the safety sheath (no further than 1 click

  • remove blue cap from needle
  • make the needle safe by re-sheathing
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15
Q

How do you prepare a patient for LA injection?

A
  1. Position them in chair
    - this is usually dictated by the type of treatment and technique
  2. Dry the mucosa - gauze or cotton wool roll
  3. Apply topical for 1-2 minutes
    - pea size on cotton wool
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16
Q

What topical gels are normally used ?

A
  1. Benzo gel

2. Xylonor, gingival gel

17
Q

What can you do to help the patient cope with injections?

A

Show them breathing exercises to help them relax

  • reduces tension
  • reduces perception of pain
18
Q

Describe the correct injection technique when using LA

A
  1. Stretch mucosa
  2. Puncture mucosa quickly
    - use distraction
  3. position needle tip at target point
  4. Bevel of needle towards bone
  5. Aspirate
    - this is to check you are not injecting IV
  6. Inject slowly
    - no less than 30 seconds
  7. Make needle safe
19
Q

How many teeth does pulpal anaesthesia effect when using infiltration?

A

1-2 teeth per injection

- also gives soft tissue anaesthesia

20
Q

What are limitations of infiltration anaesthesia?

A
  1. Infection may limit effect

2. Dense bone may limit effect

21
Q

What are advantages of infiltration anaesthesia?

A
  1. High success rate
  2. Technically easy
  3. atraumatic
22
Q

Describe the correct technique used for buccal infiltration of LA

A
  1. Stretch cheek
  2. Puncture mucosa With correct bevel of needle
  3. Advance needle until over the apex of the tooth
  4. If you contact bone, withdraw slightly
  5. Aspirate
    - if negative inject slowly
    - if positive reposition and repeat
23
Q

Describe what should be done after the LA has been delivered (buccal infiltration)

A
  1. Remove syringe from mouth
  2. Slide sheath down to first click
  3. Can replace cartridge if there is need for further injections
  4. Massage local anaesthetic into tissues
  5. Wait for 2 minutes for anaesthesia
  6. Test
24
Q

Describe how to carry out a palatal infiltration of LA

A
  1. Short needle
  2. Area of needle penetration is 5-10mm palatal to the centre of the crown
  3. Apply pressure directly behind the injection site with a cotton swab or mirror handle if desired
  4. Insert needle at 45 degree angle to the injection site, with the bevel angled toward the soft tissue
  5. While maintaining pressure behind the injection site, advance the needle and slowly deposit anaesthetic as soft tissue is penetrated
  6. Advance needle until contact is made with bone
25
Q

What causes resistance to deposition of local anaesthetic palatally?

A

The tissue is very firmly adherent to the underlying periosteum in this region

26
Q

How much LA is required to cause adequate palatal anaesthesia?

A

0.2-0.4 ml

27
Q

What palatal blocks are available in the maxilla and what areas are affected by them?

A
  1. Greater palatine
    - posterior portion of hard palate and overlying soft tissues as far as
    - first premolar and medially to midline
  2. Nasopalatine
    - anterior portion of hard palate (soft and hard tissue) bilaterally from mesial of right first premolar to the mesial of left first premolar
28
Q

Where do you inject to perform a mental nerve block and what must you NOT do?

A
  1. Between apices of lower premolars
    - massage the LA
  2. Do NOT try to put needle in foramen
29
Q

Where should you inject LA for a buccal injection in the lower arch?

A

Administer to the buccal gingivae slightly distal from the tooth to be treated

30
Q

How do you prepare for an inferior alveolar nerve block?

A
  1. Prepare the equipment and patient as for buccal infiltration
    - but use 35mm needle
  2. Identify site for LA
  3. Patient opens mouth
    - wide stretch
    - easier land marks
    - taut tissue
31
Q

What anatomical landmarks are important to look for when performing an inferior alveolar nerve block?

A
  1. Coronoid notch of the mandibular Ramus
  2. Posterior border of mandible
  3. Pterygomandibular raphe
  4. Lower premolar teeth of the opposite side
  5. The site of anaesthetic deposition is in the region of the mandibular foramen
32
Q

(for IDB) Where should the needle be placed in relation to the occlusal plane of the teeth below?

A

6-10 mm above the occlusal plane

33
Q

Describe how to find the correct location for an inferior alveolar nerve block

A
  1. Thumb placed at anterior notch
  2. Needle entry at junction of buccal pad of fat/pterygomandibular raphe
  3. Syringe lies over contra lateral 5-6
  4. Advance to bony contact (1cm of needle visible)
  5. If no bony contact, reposition syringe distally
  6. If bony contact too soon, reposition mesially
  7. When in correct position, withdraw from bony contact
  8. Aspirate
  9. Inject slowly
    - for lingual anaesthesia withdraw while injecting last 1/3 of solution
34
Q

How do you confirm anaesthesia with the patient?

A
  1. Ask the patient how it feels
    - rubbery
    - numb
    - swollen/fat
    - tingly

For Inferior alveolar nerve block

  • tongue and lower lip extending to the mid line on that side should feel different
  • ability to sense pressure remains

BDS2: LA Symposium (7 decks)

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