Local Complications in Anesthesia Administration

Local Complications Needle breakage Pain on injection Burning on injection Persistent anesthesia or paresthesia Lip chewing

Local Complications TrismusHematomaInfectionEdema Sloughing of tissues

Local Complications Facial nerve paralysis Post-anesthetic intraoral lesions Local Complications Written documentation is mandatory Written documentation is mandatory Follow-up care should be arranged Follow-up care should be arranged

Needle Breakage Causes Unexpected movement Unexpected movement Small needle size Small needle size Bent needles Bent needles Defective needles Defective needles

Needle Breakage Prevention Use large needles Use large needles Use long needles for deep injection,>18mm Use long needles for deep injection,>18mm Never insert to hub Never insert to hub Redirect only when adequately withdrawn Redirect only when adequately withdrawn

Needle Breakage Management Remain calm Remain calm Don't explore Don't explore Have the patient keep opening wide Have the patient keep opening wide If the needle is out remove it If the needle is out remove it Refer to an Oral Surgeon Refer to an Oral Surgeon

Pain on Injection Causes Careless technique Careless technique Dull needles Dull needles Rapid deposit of solution Rapid deposit of solution Needles with barbs Needles with barbs

Pain on Injection Prevention Careful technique Careful technique Sharp needles Sharp needles Topical anesthetic Topical anesthetic Slow injections Slow injections Room temperature solutions Room temperature solutions

Burning on Injection Causes pH of solution pH of solution Rapid injection Rapid injection Contamination Contamination Warmed solutions Warmed solutions

Persistent Anesthesia or Paresthesia Causes Trauma to nerve Trauma to nerve Neurolytic agents (alcohol, phenol) Neurolytic agents (alcohol, phenol) Intraneural injection Intraneural injection Hematoma Hematoma

Persistent Anesthesia or Paresthesia Prevention Careful injection technique Careful injection technique Unavoidable at times Unavoidable at times

Persistent Anesthesia or Paresthesia Management Patient counseling and reassurance Patient counseling and reassurance Documentation Documentation Follow-up Follow-up Appropriate referral Appropriate referral

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

Trismus Causes Trauma to muscles or blood vessels Trauma to muscles or blood vessels Contaminated anesthetic solutions Contaminated anesthetic solutions Hemorrhage Hemorrhage Infection Infection Excessive anesthetic volume Excessive anesthetic volume

Trismus Prevention Sharp needles Sharp needles Proper care and handling of cartridges Proper care and handling of cartridges Aseptic technique and clean injection site Aseptic technique and clean injection site Atraumatic insertion Atraumatic insertion Minimal injections and volume Minimal injections and volume

Trismus Management Examination Examination Conservative therapy Conservative therapy passive ROM therapy passive ROM therapy analgesics analgesics heat heat muscle relaxants muscle relaxants

Hematoma The effusion of blood into extravascular spaces

Hematoma Prevention Care with needle placement Care with needle placement Minimize injections Minimize injections Don't probe with needle Don't probe with needle Modify technique Modify technique short needles short needles penetration depth penetration depth

Hematoma Management with IAN block IAN block Infraorbital block Infraorbital block Mental Nerve block Mental Nerve block Buccal block Buccal block PSA block PSA block

Infection Causes Needle contamination Needle contamination Improper handling of armamentarium Improper handling of armamentarium Infection at injection site Infection at injection site Improper handling of tissue Improper handling of tissue

Infection Prevention Disposable needles Disposable needles Proper care of equipment Proper care of equipment Aseptic technique Aseptic technique

Infection Management Usual sign is trismus Usual sign is trismus Trismus persists (1-3 day resolution ) Trismus persists (1-3 day resolution ) Antibiotics, if suspicious Antibiotics, if suspicious

Edema Causes Trauma during injection Trauma during injection Infection Infection Allergy Allergy Hemorrhage Hemorrhage Irritating solutions Irritating solutions

Edema Management Address cause Address cause Treat accordingly Treat accordingly hemorrhage hemorrhage allergy allergy infection infection

Sloughing of Tissue Causes Topical anesthetic Topical anesthetic Prolonged ischemia Prolonged ischemia

Sloughing of Tissue Management Observation Observation Documentation Documentation

Lip Chewing Management Analgesics Analgesics Antibiotics Antibiotics Saline rinses Saline rinses Lip lubricants Lip lubricants

Facial Nerve Paralysis Cause Anesthesia of peripheral Facial nerve branches Anesthesia of peripheral Facial nerve branches Temporal Temporal Zygomatic Zygomatic Buccal Buccal Mandibular Mandibular Cervical Cervical

Facial Nerve Paralysis Prevention Bone contact when injecting Bone contact when injecting Avoid over penetration Avoid over penetration Avoid arbitrary injection Avoid arbitrary injection

Facial Nerve Paralysis Management Reassure patient Reassure patient Cornea care Cornea care Documentation Documentation Consider deferring dental care Consider deferring dental care

Post Anesthetic Intraoral Lesions Recurrent apthous Herpes Simplex