Local Complications in Anesthesia Administration

Local ComplicationsLocal Complicationsinin

Anesthesia AdministrationAnesthesia Administration

Local ComplicationsLocal Complications

Needle breakageNeedle breakage

Pain on injection Pain on injection

Burning on injection Burning on injection

Persistent anesthesia or paresthesiaPersistent anesthesia or paresthesia

Lip chewingLip chewing


TrismusTrismus

HematomaHematoma

InfectionInfection

EdemaEdema

Sloughing of tissuesSloughing of tissues


Facial nerve paralysisFacial nerve paralysis

Post-anesthetic intraoral lesionsPost-anesthetic intraoral lesions


Written documentation is mandatoryWritten documentation is mandatory

Follow-up care should be arrangedFollow-up care should be arranged

Needle BreakageNeedle Breakage

CausesCauses

Unexpected movementUnexpected movement

Small needle sizeSmall needle size

Bent needlesBent needles

Defective needlesDefective needles


PreventionPrevention

Use large needlesUse large needles

Use long needles for deep injection,>18mmUse long needles for deep injection,>18mm

Never insert to hubNever insert to hub

Redirect only when adequately withdrawnRedirect only when adequately withdrawn


ManagementManagement

Remain calmRemain calm

Don't exploreDon't explore

Have the patient keep opening wideHave the patient keep opening wide

If the needle is out remove itIf the needle is out remove it

Refer to an Oral SurgeonRefer to an Oral Surgeon

Pain on InjectionPain on Injection

CausesCauses

Careless techniqueCareless technique

Dull needlesDull needles

Rapid deposit of solutionRapid deposit of solution

Needles with barbsNeedles with barbs

Pain on InjectionPain on Injection


Careful techniqueCareful technique

Sharp needlesSharp needles

Topical anestheticTopical anesthetic

Slow injectionsSlow injections

Room temperature solutionsRoom temperature solutions

Burning on InjectionBurning on Injection

CausesCauses

pH of solutionpH of solution

Rapid injectionRapid injection

ContaminationContamination

Warmed solutionsWarmed solutions

Persistent AnesthesiaPersistent Anesthesiaor Paresthesiaor Paresthesia

CausesCauses

Trauma to nerve Trauma to nerve

Neurolytic agents (alcohol, phenol)Neurolytic agents (alcohol, phenol)

Intraneural injectionIntraneural injection

HematomaHematoma



Careful injection techniqueCareful injection technique

Unavoidable at timesUnavoidable at times



Patient counseling and reassurancePatient counseling and reassurance

DocumentationDocumentation

Follow-upFollow-up

Appropriate referralAppropriate referral

TrismusTrismus

A motor disturbance of the trigeminal nerve A motor disturbance of the trigeminal nerve precipitating or resulting in spasm of precipitating or resulting in spasm of

the muscles of masticationthe muscles of mastication

TrismusTrismus

CausesCauses

Trauma to muscles or blood vesselsTrauma to muscles or blood vessels

Contaminated anesthetic solutionsContaminated anesthetic solutions

HemorrhageHemorrhage

InfectionInfection

Excessive anesthetic volumeExcessive anesthetic volume

TrismusTrismus


Sharp needlesSharp needles

Proper care and handling of cartridgesProper care and handling of cartridges

Aseptic technique and clean injection siteAseptic technique and clean injection site

Atraumatic insertionAtraumatic insertion

Minimal injections and volumeMinimal injections and volume

TrismusTrismus


ExaminationExamination

Conservative therapyConservative therapy

passive ROM therapypassive ROM therapy

analgesicsanalgesics

heatheat

muscle relaxantsmuscle relaxants

HematomaHematoma

The effusion of blood into extravascular The effusion of blood into extravascular spacesspaces

Hematoma Hematoma


Care with needle placementCare with needle placement

Minimize injectionsMinimize injections

Don't probe with needleDon't probe with needle

Modify techniqueModify technique

short needlesshort needles

penetration depthpenetration depth

HematomaHematoma

Management withManagement with

IAN blockIAN block

Infraorbital blockInfraorbital block

Mental Nerve blockMental Nerve block

Buccal blockBuccal block

PSA blockPSA block

InfectionInfection

CausesCauses

Needle contaminationNeedle contamination

Improper handling of armamentariumImproper handling of armamentarium

Infection at injection siteInfection at injection site

Improper handling of tissueImproper handling of tissue

InfectionInfection


Disposable needlesDisposable needles

Proper care of equipmentProper care of equipment

Aseptic techniqueAseptic technique

InfectionInfection


Usual sign is trismusUsual sign is trismus

Trismus persists (1-3 day resolution )Trismus persists (1-3 day resolution )

Antibiotics, if suspiciousAntibiotics, if suspicious

EdemaEdema

CausesCauses

Trauma during injectionTrauma during injection

InfectionInfection

AllergyAllergy

HemorrhageHemorrhage

Irritating solutionsIrritating solutions

EdemaEdema


Address causeAddress cause

Treat accordinglyTreat accordingly

hemorrhagehemorrhage

allergyallergy

infectioninfection

Sloughing of TissueSloughing of Tissue

CausesCauses

Topical anestheticTopical anesthetic

Prolonged ischemiaProlonged ischemia

Sloughing of TissueSloughing of Tissue


ObservationObservation


Lip ChewingLip Chewing


AnalgesicsAnalgesics

AntibioticsAntibiotics

Saline rinsesSaline rinses

Lip lubricantsLip lubricants

Facial Nerve ParalysisFacial Nerve Paralysis

CauseCause

Anesthesia of peripheral Facial nerve branchesAnesthesia of peripheral Facial nerve branches

TemporalTemporal

ZygomaticZygomatic

BuccalBuccal

MandibularMandibular

CervicalCervical



Bone contact when injectingBone contact when injecting

Avoid over penetrationAvoid over penetration

Avoid arbitrary injectionAvoid arbitrary injection



Reassure patientReassure patient

Cornea careCornea care


Consider deferring dental careConsider deferring dental care

Post Anesthetic Intraoral LesionsPost Anesthetic Intraoral Lesions

Recurrent apthousRecurrent apthous

Herpes SimplexHerpes Simplex

Documents

Local Complications in Anesthesia Administration