Local Complications of Local Anaesthesia PDF

## Local Complications of Local Anaesthesia A complication is any deviation from normally expected effect during or after LA administration. **Classification:** * **Primary:** which manifests at time of surgery or **secondary:** which manifests later * **Mild:** which is a slight change from norm...

## Local Complications of Local Anaesthesia A complication is any deviation from normally expected effect during or after LA administration. **Classification:** * **Primary:** which manifests at time of surgery or **secondary:** which manifests later * **Mild:** which is a slight change from normally expected pattern, and is self-limiting or **severe:** where a pronounced effect occurs and requires definite treatment * **Transient:** leaves no residual effect or **permanent:** leaves residual effect even if mild * **Due to the solution** or **due to needle insertion** * **Local** or **general** **Complications can also be divided into:** 1. **Those attributed to the solution:** toxicity (LA agent and or the VC), allergy (anaphylaxis, ....), idiosyncrasy, local reactions, infection, and local tissue damage. 2. **Those attributed to needle insertion:** syncope, pain, muscle trismus, edema, haematoma and ecchymosis, infection, Local tissue damage, needle breakage, prolonged anaesthesia, and bizarre neurological symptoms. **In order to avoid these side effects as much as possible (to offer the patient a safe procedures and to avoid medico-legal issues), a thorough history taking and careful examination should be performed. The following items have to be checked:** 1. The general medical status of the patient and the local tissues conditions are considered 2. Consultation and referral to the physician 3. Proper premedication if needed 4. Selection of the LA technique and material (LA agent, VC,.....) 5. Correct estimation of the needed amount and conc. of the LA and VC 6. Strict apsesis maintenance and perfect sterilization. 7. Preparation and continuous scheduled checkup for the emergencies kits and equipments (first aids and life-saving measures) and continuous training of the staff on these measures. Now let's be more specific, the local complication could be: 1. Pain or burning sensation on injection 2. **Write short notes through what you learned through the lecture and the practical sessions.** 3. Edema 4. **Write short notes through what you learned through the lecture and the practical sessions.** **Other possible complications:** * **Trismus:** is often associated with pain. Analgesics, massaging, heat application with warm mouth washes and sugarless gum chewing is the first line of treatment. Physiotherapy may be indicated. Antibiotics (with incision and drainage of pus if found) should be prescribed if infection is suspected. If no improvement within 7 days, gently press the mouth to open under GA to break down fibrous bands formed due to hematoma formation in the muscle pterygoid muscle region. * **Failure to obtain anaesthesia:** It might be the most common local complication. * If infiltration LA 1. Deposition in a faulty site too away from the bone as when penetrating too deep into the soft tissues even might make intramuscular injection * If in block LA 1. Insufficient knowledge of the region anatomy * **Prolonged anaesthesia or paresthesia (: abnormal sensation such as numbness, tingling or pricking)** * **Write short notes through what you learned through the lecture and the practical sessions.** * Occasionally, hyperesthesia (: increased sensitivity to stimuli) or dysesthesia (: abnormal touch sensation) may develop. * All these conditions are unpleasant and might be associated with injuries (mechanical, thermal,...) due to diminished sensation. * The majority of these cases is self-limiting within two to three months. If this did not happen, a surgical repair might be indicated. So you have to reassure and examine the patient and consult a neurosurgeon or an oral and maxillofacial surgeon. At all circumstances, do not inject an anesthetic at the nerve trauma site. * **Facial nerve paralysis** * **Hematoma:** Write short notes through what you learned through the lecture and the practical sessions. * **Infection:** Due to contaminated needle or solution or injecting in an inflamed or infected area. Trismus may follow. Antibiotics should be prescribed. Incision and drainage should be performed in and abscess is formed. * **Postanesthetic lesions:** As recurrent aphthus ulcerations * **Trismus:** It is difficulty in opening the mouth due to mouth spasm. This is caused by muscle insult due to multiple pricks, infection (source: contaminated needle of spread from infected site of injection and infection lead to pain, pyrexia, general malaise and lymphadenitis in addition to trismus) or chemical irritation from the anaesthetic solution or blood originating from haemorrhage. Very rare, chronic trismus due to scar contracture occurring after fibrosis which is a sequel of haematoma organization. Moreover, the most common causes are multiple pricks