LOCAL ANESTHESIA Dr.
Tooba Saeed
Assistant Professor
Oral & Maxillofacial Surgery
Learning Objectives
• Define local anesthesia
• Differentiate between types of local anesthetic drugs
• Enlist ideal properties of local anesthetic drugs
• Describe mechanism of action of local anesthetic drugs
• Recall Factors which affect properties of local anesthetic
drugs
• Enumerate ingredients of dental cartridge
• Describe side effects of local anesthetic drugs
• Identify parts and uses of armamentarium of local
anesthesia
Definition
• “Loss of sensation in a circumscribed area of the body
caused by depression of excitation in nerve endings or
an inhibition of the conduction process in peripheral
nerves.”
• Loss Of Sensation Without
Inducing Loss Of Consciousness..
Properties of Local Anesthesia
• Should not be irritating to the area of
application
• Must be effective regardless of application to
tissues or mucous membrane
• Should have short time of onset Should have long
duration of action to permit completion of procedure
• Should have potency sufficient enough to give
complete anesthesia
Properties of Local Anesthesia
• Should not cause permanent alteration of nerve
structure
• Should have low systemic toxicity
• Should be relatively free from allergic reactions
• Should be stable in solution & readily undergo
biotransformation in the body
• Should either be sterile or capable of being
sterilized by heat without deterioration
Electrophysiology Of Nerve Conduction
Depolarization takes 0.3 msec
Repolarization takes 0.7 msec
The entire process require 1 msec
• Unmyelinated Nerves: 1.2 m/ sec
• Myelinated Nerves: 120 m/sec
Theories of Mechanism of Action of
Local Anesthesia
• Acetylcholine Theory
• Surface Charge (Repulsion Theory)
• Calcium Displacement Theory
• Membrane Expansion Theory
• Specific Receptor Theory
Mode & Site of Action
• Altering the basic resting potential of nerve membrane
• Altering the threshold potential
• Decreasing the rate of depolarization
• Prolonging the rate of repolarization
Mode & Site of Action
Displacement of Calcium ions from sodium channel receptor site
Binding of the LA molecule to this receptor site
Blockade of the sodium channel
Decrease in sodium conductance
Depression of rate of electrical depolarization
Failure to achieve threshold potential level
Lack of Action Potential
Conduction Blockade
Classification
Esters Amides
Esters of benzoic acid : - Articaine
- cocaine
- Bupivacaine
- tetracaine
- Benzoacaine - Lidocaine
- piperocaine - Mepivacaine
Esters of - Prilocaine
paraaminobenzoic acid:
- Ropivacaine
- Procaine
- Chloroprocaine
- Propoxycaine
Composition of Local Anesthetic Solution
Component Function
• Local Anesthetic drug • Blockage of nerve conduction
(e.g. Lignocaine HCL)
• Vasopressor (e.g. epinephrine, • Inc. depth & duration of
levonordefrin) anesthesia
• Dec. absorption of L.A.
• Sodium chloride • Isotonicity of the solution
• Sterile water • Volume
• Sodium (meta) bisulfite • Antioxidant
• Methylparaben • Bacteriostatic agent, fungicidal
Factors in Selection of L.A. for a Patient
• Length of time pain control is necessary
• Potential need for post treatment pain control
• Possibility of self mutilation in the postoperative
period
• Requirement for hemostasis
• Presence of any contraindication
(absolute/relative) to the use of LA selected for
administration
Local Anesthesia Armentarium
• The Syringe
• The Needle
• The Cartridge
• Other Armamentarium
- Topical Anesthetic (strongly
recommended)
-ointments, gels, pastes, sprays
- Applicator sticks
-Cotton gauze
Syringe Components
• Needle adapter
• Piston with harpoon
• Syringe barrel
• Finger grip
• Thumb ring
Components of needle
• Usual dental needle gauges are 25,27, &
30Length:
• Long(approximately 40 mm "32-40mm")
• Short(20-25 mm)
• Extra-short(approximately 15 mm)
Complications of Local Anesthesia
• Pain on Injection
• Burning on injection
• Infection
• Soft Tissue Injury
• Hematoma
• Sloughing of tissue
Complications of Local Anesthesia
• Needle breakage
• Prolonged anesthesia / Paraesthesia
• Facial Nerve Palsy
• Trismus
• Edema (Allergic reaction)
• L.A. Toxicity
Task
• Why Local anesthesia is not effective in presence of
infection?
• How to manage this problem?
THANK YOU
References
• Hupp, James R., Edward Ellis, and Myron R. Tucker. Contemporary Oral and
Maxillofacial Surgery. St. Louis, Mo: Mosby Elsevier, 2008.
• Malamed S.F, Handbook of Local anesthesia. St. Louis, Mo: Mosby Elsevier, 2004.
• Milam, S & Giovannitti, Joseph. (1984). Local anesthetics in dental practice. Dental
clinics of North America. 28. 493-508.
• Images from google
