PAIN CONTROL.pptx

PAIN CONTROL “For there was never yet a philosopher, who could endure the toothache patiently”. William Shakespeare Local Anaesthesia The administration of local anaesthesia to all tissues in the operating site is recommended in certain patients to eliminate pain and reduce salivation associated wit...

PAIN CONTROL “For there was never yet a philosopher, who could endure the toothache patiently”. William Shakespeare Local Anaesthesia The administration of local anaesthesia to all tissues in the operating site is recommended in certain patients to eliminate pain and reduce salivation associated with tooth preparation and restoration. CLINICAL NOTES A therapeutic dose of a drug is the smallest amount that is effective when properly administered and does not cause adverse reactions. An overdose of a drug is an excessive amount that results in an overly elevated local accumulation or blood level of the drug, which causes adverse reactions. Each 1.8 ml cartridge contains anesthetic, with or without a vasoconstrictor (e.g. lidocaine 2% [anesthetic] with epinephrine 1:100,000 [vasoconstrictor], lidocaine 2% plain [no vasoconstrictor]). The number of permissible cartridges increases as body weight increases. The maximum recommended dose of 2% lidocaine with epinephrine 1: 100,000 is 4.4 mg/kg, Local anesthetics have different durations of action for pulpal and soft-tissue anaesthesia. Pulpal (deep) anaesthesia varies from 30 to 90 or more minutes. Soft-tissue anaesthesia varies from 1 to 9 h, depending on the specific agent and whether or not a vasoconstrictor is included. Local anesthetics are selected on the basis of the estimated length of the clinical procedure and the degree of anaesthesia required Clinical Considerations Patient Factors 1- Cardiovascular System According to the latest guidelines, patients with stage 1 hypertension are good candidates for all dental procedures: j Systolic pressure less than 140 mmHg. j Diastolic pressure less than 90 mmHg. Patients with blood pressure consistently greater than the aforementioned numbers (stage 2 hypertension) should be referred to their physicians, particularly if the elevation is greater than 20 mmHg. Any resting patient with the following pulse rates be questioned further: j Pulse rate less than 60 beats per minute (beats/min). j Pulse rate greater than 110 beats/min. Overdose of any vasoconstrictor causes increased blood pressure, elevated heart rate and possible dysrhythmias. 2- Central Nervous and Respiratory Systems The central nervous system (CNS) is more easily affected by overdose of injected anesthetic drugs than the cardiovascular system. Anesthetics depress the CNS, but when administered properly for local anaesthesia, little or no clinical evidence of depression is encountered. At minimal to moderate overdose levels, depression is manifested in excitation (e.g. talkativeness, apprehension, sweating, elevated blood pressure and heart rate, elevated respiratory rate) or drowsiness. At moderate to high overdose levels, tonic–clonic seizure activity may occur, followed by generalized CNS depression, depressed blood pressure, reduced heart rate (