update of local anesthesia
TRANSCRIPT
-
7/30/2019 Update of Local Anesthesia
1/21
PUTRI
MAHFUZAH 160112123009
SUGANYA 160112123012MOHD AZRUL 160112123008
-
7/30/2019 Update of Local Anesthesia
2/21
Local Anasthesia:
Lidocaine
Hydrogen Chloride
Purpose (1948):
pain free treatment a pain free post
treatment period
Complains:
lingering numbness of
residual STA
inconvinient,uncomfortable, lead
to soft tissue injury
(children)
-
7/30/2019 Update of Local Anesthesia
3/21
Expected Durations of Pulpal and Soft Tissue
Anesthesia (STA)
Vasopressor Pulpal anesthesia (minutes) STA (minutes)
SHORT-DURATION
Mepivacaine hydrogen
chloride (HCl)none
20 to 30 (infiltration)
30 to 45 (nerve block)90 to 120
Prilocaine HCl None
10 to 15 (infiltration)
60 to 120 (infiltration)
45 to 65 (nerve block)
120 to 240 (nerve block)
INTERMEDIATE-DURATION
Articaine HCl1:100,000
1:200,000
60 (infiltration)
up to 120 (nerve block)180 to 240
Lidocaine HCl1:50,000
1:100,000
55 to 65 (infiltration)
80 to 90 (nerve block)180 to 300
Mepivacaine HCl1:20.000 levonordefrin 40 to 60 (infiltration)
60 to 90 (nerve block)180 to 300
Prilocaine HCl 1:200,00035 to 45 (infiltration)
50 to 70 (nerve block)180 to 480
LONG-DURATION
Bupivacaine HCl 1:200,000Up to 7 hours (infiltration)
Up to 7 hours (nerve block)240 to 720
Short acting drugs:
Mepivacaine HCl 3% Prilocaine HCl 4%
Pulpal anasthesia for
30 miniutes
Fail to meet the pain
control needs
dental treatment 44
minutes
Intermediet duration drugs:
Articaine HCl 4% with epinephrine
1:100.000 and 1:200.000 lidocaine HCl 2% with epinephrine
1:50.000 and 1:100.000
Mepivacaine HCl 2% with levonordefrin
1:20.000 Prilocaine HCl 4% with epinephrine
1:200.000
Most often use for dental treatment
because it has an inclusion with vasopresor
Duration 60 minutes
Long duration drugs:
bupivacaine HCl 0.5 %
+ epinephrine 1:200.000 (nerve block)
Pulpal anasthesia for 7
hours
With STA 12 hours
-
7/30/2019 Update of Local Anesthesia
4/21
To determine a local anasthesia depends on the
treatment and the choice of LA technique:
curetagge periodontal surgery
extractions
implants
subgingival tooth preparation
Technique of LA:
infiltration
nerve blocks (inferior alveolar Gow-Gates)
intraligamentary injection new technique
intrasseous injection with minimum of
associated LA
-
7/30/2019 Update of Local Anesthesia
5/21
Residual STA
Present as inconvinience or
embarrassment to the patient, including 3major areas:
functional
sensory
perceptual
Functional :
diminished ability to speak
(lisping) to smile (asymmetric)
to drink (liquids runs out
from the mouth)
the in abillity to controldrooling while still numb
Sensory:
lack of sensation
discomfort
Perceptual:Perception that their
body was distorted
(swollen lips)unpleasant
-
7/30/2019 Update of Local Anesthesia
6/21
Residual STA
Can lead to self-inflicted injury (lip/tongue) in
any patient:
younger children
mentally disabled adult and pediatric
patients
geriatric patients with dementia greatestrisk of soft-tissue injury
Soft tissue injury
-
7/30/2019 Update of Local Anesthesia
7/21
Incidence of Lip Injury Following
Inferior Alveolar Nerve Block
Age (years) % with soft tissue injury to lip
12 7
-
7/30/2019 Update of Local Anesthesia
8/21
Phentolamine Mesylate(OraVerse)
Phentolamine Mesylate
(Oraverse)
-
7/30/2019 Update of Local Anesthesia
9/21
INTRODUCTION
Phentolamine is a non-selective competitive
alpha adrenergic receptor antagonist.
It is a short acting antagonist andantagonizes both alpha and alpha
receptors, thus blocking the actions of the
circulating catecholamine, epinephrine andnor-epinephrine.
-
7/30/2019 Update of Local Anesthesia
10/21
-
7/30/2019 Update of Local Anesthesia
11/21
INTRODUCTION
Ultimate Effect of alphareceptor blockade
VASODILATION
Rapid distribution of local anesthetic solutionaway from the injection site
-
7/30/2019 Update of Local Anesthesia
12/21
METHOD
Patient receives a traditional intraoralinjection at the onset of the treatment.
At the end of the traumatic portion of the dental procedurePM injection / sham injection at the same site.
All patients were observed for 5 hours to collect efficacyand safety data and then monitored for up to 48 hours.
-
7/30/2019 Update of Local Anesthesia
13/21
First endpoint: return of normal lip sensation
from the patients response to lip palpation
Second endpoint: patients perception of
altered function, sensation and appearance,
functional deficits in smiling, speaking,
drinking and drooling.
Impact of functional deficitspatients
response (STAR questionnaire)
-
7/30/2019 Update of Local Anesthesia
14/21
-
7/30/2019 Update of Local Anesthesia
15/21
Functional Assessment Battery (FAB):measurements of smiling, speaking, drooling,
drinking 3 ounces of water at various timepoints during the study.
Heft-Parker Visual Analogue Scale (H-P VAS):a 170 mm visual analog scale containing thefollowing verbal descriptors: none, faint,weak, mild, moderate, strong, intense, andmaximum possible.
*Patients were asked to place a mark on the line thatcorresponded to their current assessment of pain atthe injection site and the procedural site.
-
7/30/2019 Update of Local Anesthesia
16/21
RESULTS
-
7/30/2019 Update of Local Anesthesia
17/21
EFFICACY OF PM:
Maxillary trial: the median time to recovery of
normal sensation in the upper lip was 50 min for
PM patients and 132.5 min for sham patients, a
reduction in anesthesia of82.5 min. Mandibular trial : the median time to recovery of
normal sensation in the lower lip was 70 min for
PM patients and 155 min for sham patients, areduction in lower lip anesthesia of85 min.
-
7/30/2019 Update of Local Anesthesia
18/21
Other Findings..
-
7/30/2019 Update of Local Anesthesia
19/21
SAFETY OF PM:
Adverse effect : diarrhea, facial swelling, increasedblood pressure/hypertension, injection sitereactions, jaw pain, oral pain, paresthesia, pruritis,tenderness, upper abdominal pain, and vomiting.
* Majority of adverse reactions were mild andresolved within 48 hours.
-
7/30/2019 Update of Local Anesthesia
20/21
CLINICAL USE AND INDICATIONS:
Not recommended foruse in children under 6years or < 15 kg.
Administration basedon the number ofcartridges of LA +vasoconstrictor - in anequal volume.
Administered at thesame location andtechnique used earlierfor the LAadministration.
-
7/30/2019 Update of Local Anesthesia
21/21