Complications of Local Anesthesia PDF

Hematoma  The effusion of the blood into extravascular spaces can result from inadvertently a blood vessel.  Casued by nicking to the artery or vein.  Most occur with IANB and PSA nerve block.  7 to 14 days the hematoma will be presented.  H...

Hematoma  The effusion of the blood into extravascular spaces can result from inadvertently a blood vessel.  Casued by nicking to the artery or vein.  Most occur with IANB and PSA nerve block.  7 to 14 days the hematoma will be presented.  Hematoma  Prevention : 1. Knowledge of normal anatomy. 2. Use shorter needle for PSA nerve block. 3. Minimize the number of the needle penetration. 4. Never use a needle as a probe in the tissue.  Management : 1. Direct pressure applied on to the site of bleeding. 2. Apply cold moist towels to affected area each 20 min. every hour. 3. Advice the patient about soreness and limitation of the mouth opening possibility.  Pain on Injection  Causes : 1. Careless injection and callous attitude “ Palatal Injection always hurt”. 2. Dull of the needle because of multiple injection. 3. Rapid deposition of the local anesthetic solution.  Pain on Injection  Prevention : ◦ Adhere to proper techniques of injection, both anatomical and psychological. ◦ Sharp needles. ◦ Topical anesthetic. ◦ Inject slowly. ◦ Temperature of the solution.  Infection  Causes : ◦ Contamination of the needle, now become rarely after introduction of the sterile disposable needle and glass cartridge.  Management : ◦ Antibiotic, penicillin 250 mg qid.  Edema  Causes : 1. Trauma. 2. Infection. 3. Allergy, angioedema. 4. Hemorrhage. 5. Injection of irritating solution(alcohol, cold solution).  Edema  Management : 1. Minimal degree edema --- just analgesic for pain and will resolve in several days. 2. If large degree edema and sign and symptom of infection--- antibiotic should be prescribed.  Allergy ◦ Hypersensitive state, acquired through exposure to a particular allergen. ◦ Allergic reactions cover a broad spectrum od clinical manifestations ranging from mild and delayed response occurring as long as 48 hours after exposure to allergen, to immediate and threatening reaction develop within seconds of exposure.  Predisposing Factors ◦ Sodium Bisulfite:  Antioxidant in vasoconstrictor local anesthesia.  1984 has been excluded. ◦ Epinephrine. ◦ Latex. ◦ Topical Anesthesia:  Mostly ester.  Preservatives containing such as methylparaben, ethylparaben, or propylparaben.  Clinical Manifestation Dermatological reaction Respiratory reactions Generalized anaphylaxis  Clinical Manifestation ◦ Dermatological reaction:  Urticaria  Angioedema  Clinical Manifestation ◦ Respiratory reactions:  Bronchospasm:  Respiratory distress  Dyspnea  Wheezing  Flushing  Cyanosis  Perspiration  Tachycardia  Anxiety  Laryngeal edema:  Extension of edema to the larynx  Life threatening emergency.  Clinical Manifestation ◦ Generalized Anaphylaxis:  Skin reactions  Smooth muscle spasm of gastrointestinal and genitourinary tracts and bronchospasm.  Respiratory distress.  Cardiovascular collapse.  Treatment of the entire reaction may be terminated rapidly, but hypotension and laryngeal edema may persist for hours to days.  Management ◦ Skin reaction:  Delayed reaction.  Immediate reaction. ◦ Respiratory reaction:  Bronchospasm.  Laryngeal edema. ◦ Generalized anaphylaxis:  Signs of allergy present.  No signs of allergy present.  Management ◦ Skin reaction:  Delayed reaction:  P-C-A-B  Oral histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine, one q6h for 3-4 days.  Observation for 1 hour.  Medical consultation.  If patient is drowsiness, not allowed to leave the clinic.  Management ◦ Skin reaction:  immediate reaction:  P-C-A-B  Epinpherine 0.3 mg IM.  IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine.  Medical consultation  Observation for 1 hour.  Prescribe Oral histamine blocker 3 days.  Management ◦ Respiratory reaction:  Bronchospasm :  P-C-A-B  Administer oxygen at flow 5-6 liters\min.  Epinpherine 0.3 IM or Bronchodilator “albuterol” , dose repeated 10-15 min. if needed.  Observation for 1 hour.  IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine.  Medical consultation  Prescribe Oral histamine blocker 3 days.  Management ◦ Respiratory reaction:  Laryngeal Edema : “unconscious patient”  P-C-A-B  Epinpherine 0.3 IM, dose repeated 10-15 min. if needed.  Activate Emergency Medical Services.  IM histamine blocker 50 mg diphenhydramine or 10 mg chlorpheniramine. Corticosteroid IM or IV (100 mg Hydrocortisone sodium succinate to inhibit and decrease edema.  Perform cricothyrotomy.  Management ◦ Generalized Anaphylaxis :  Signs of allergy present : “unconscious patient”  P-C-A-B  Summon medical assistance.  Epinpherine 0.3 IM, dose repeated 10-15 min  Administer oxygen.  Monitor vital signs, recorded every 5 min.  IM histamine blocker and Corticosteroid IM or IV “ If clinical improvement noted increased blood pressure, decreased bronchospasm”  Management ◦ Generalized Anaphylaxis :  No signs of allergy present : “unconscious patient”  P-C-A-B  Summon medical assistance.  Administer oxygen.  Monitor vital signs, recorded every 5 min.  Addition management, on arrival of the emergency medical personnel depend on the cause of the loss of consciousness.  References: 1. Stanley F. Malamed. Handbook of local anesthsia. 5th edition. Page 285-332. 2. Sean G. Boynes, Zydnia Echeverria, Mohammad Abdulwahab. Ocular Complications Associated with Local Anesthesia Administration in Dentistry. Dent Clin N Am 54 (2010) 677–686 3. Ngeow WC, Shim CK, Chai WL. Transient loss of power of accommodation in one eye following inferior alveolar nerve block: report of two cases. J Can Dent Assoc 2006;72:927–31. 4. Penarrocha-Diago M, Sanchis-Bielsa JM. Opthalmologic complications after intraoral local anesthesia with articaine. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:21–4. 5. Lee C. Ocular complications after inferior alveolar nerve block. Hong Kong Med Diary 2006;11:4–5. 6. Van der Bijil P, Meyer D. Ocular complications of dental local anesthesia. SADJ 1998;53:235–8. 7. Goldenberg AS. Transient diplopia as result of block injections. Mandibular and posterior superior alveolar. N Y State Dent J 1997;63:29–31.