Regional Dental Nerve Blocks

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Regional Dental Nerve Blocks
2012-11-22 12:08:36
Clinical Practice ll

Clinical Practice ll
Show Answers:

  1. What are the benefits to doing a nerve block?
    • decreases the amount of injectable and gas inhalants needed
    • lower cost
    • increase patient safety since lower levels of general anes are needed
    • decreased recover time
    • greater patient comfort
  2. With decreased recovery time, what else does it decrease?
    decreased risk of hypertension, tachycardia, and tachypnea due to decreased oral pain
  3. What are the risks of using dental nerve blocks?
    • injection into circulation could cause myocardial depression and cardiac dysrhythmia
    • ocular damage caused by improper infraorbital nerve block technique
    • cheek or tongue damage during recovery
  4. What are the different types of local anesthetics used in dentistry?
    • infiltration anesthesia
    • splash technique
    • regional nerve block
  5. What does infiltration anesthesia involve?
    applying small amounts of local anesthesia into the gingiva, mucosa, periodontal ligament space/alveolar periosteum
  6. When would you use infiltration anesthesia?
    used only for small number of teeth that need to be blocked or as adjunct to intraorbital blocks
  7. How do we do the splash technique?
    anesthetic agent is dropped onto or into area being treated
  8. Is the splash technique as successful as infiltration or regional nerve blocks?
  9. What are regional dental nerve blocks not indicated for?
    routine dental cleaning procedures
  10. When should we use regional dental nerve blocks?
    for all painful oral surgeries and should be preceded by regional nerve blocks
  11. What are considered painful oral surgeries?
    • tumor resection
    • biopsy
    • reconstruction surgery
    • oral lacerations, foreign bodies
    • jaw fractures
    • fractured teeth
    • root canals
    • pulptomies
    • extractions
    • flap surgery and root planning
    • oral resorptive lesions
  12. How do we do regional nerve blocks?
    local anesthetic agent is injected just into the foramen
  13. What are the different foramens that we can inject regional nerve blocks into?
    • inraorbital foramen
    • palatine/maxillary foramen
    • inferior alveolar foramen (mandibular block)
    • mental foramen
  14. What kind of equipment do we need for nerve blocks?
    • drugs
    • 25 - 22g needles with 5/8 - 1 inch length
    • 1 - 3 cc syringes
    • surgical scrub
    • dog and cat skulls for anatomical guidance
  15. What is the onset time for lidocaine?
    5 - 10 minutes
  16. What is the duration of lidocaine?
    60 - 90 minutes
  17. What is the dose for lidocaine?
    2% lidocaine 2 mg/kg
  18. How much lidocaine would we use for a 4 lb animal?  5 lbs?  10 lbs?
    • 4 lbs:  0.18 ml
    • 5 lbs:  0.22 ml
    • 10 lbs:  0.45 ml
  19. How can we expand the volume of lidocaine we need to use?
    add it to saline
  20. How can we reduce the stinging of lidocaine?
    and 1/10 of volume as sodium bicarbonate (example - if using 1 ml of lidocaine add 0.1 ml of sodium bicarbonate)
  21. What is the onset time of bupivicaine?
    15 - 30 minutes
  22. What is the duration of bupivicaine?
    4 - 8 hours
  23. What is the dose for bupivicane?
    0.5% bupivicaine 2 mg/kg
  24. How much bupivicaine would we use for a 4 lb animal?  5 lbs?  10 lbs?  50 lbs?
    • 4 lbs:  0.72 ml
    • 5 lbs:  0.90 ml
    • 10 lbs:  1.8 ml
    • 50 lbs:  9 ml
  25. How can we expand the volume of bupivicaine?
    mix with saline
  26. How can we reduce the sting of using bupivicaine?
    add 1/10 volume as sodium bicarbonate (example:  is using 1 ml of bupivicaine add 0.1 ml of sodium bicarbonate)
  27. If we are using lidocaine and bupivicaine, what should we do?
    cut doses in half
  28. What is the average dose of bupivcaine for dogs?
    • 0.5 - 1.0 ml per site in dogs
    • the cumulative dose during any procedure should not exceed 2 mg/kg
  29. What is the average dose of bupivicaine for cats?
    • 0.01 - 0.3 ml per site
    • the cumulative dose during any procedure should not exceed 2 mg/kg
  30. What is the onset of mepvacaine?
    quick onset
  31. What is the duration of mepivacaine?
    2 - 2.5 hours
  32. What is the dose of mepivacaine for dogs?  cats?  maximum dose?
    • dogs:  0.25 - 1 ml depending on size
    • cacts:  0.25 - 0.5 ml depending on size
    • maximum dose:  2 mg/kg
  33. Is mepivicaine less toxic than lidocaine and bupivicaine?
  34. What is the onset when mixing lidocaine and bupivicaine?  Duration?
    • onset:  5 - 10 minutes from the lidocaine
    • duration:  4 - 6 hours from bupivicaine
  35. What is the duration when mixing lidocaine and bupivicaine?
    4 - 6 hourse
  36. Why do we mix lidocaine and bupivicaine?
    for balanced anesthesia
  37. How much lidocaine and bupivicaine should we use for dogs?  Cats & small dogs?
    • dogs:  0.1 - 1.0 ml per site
    • cats & small dogs:  0.1 - 0.3 ml per site
  38. What does epinephrine do to the drugs?
    lengthens the effects of the agents by 50%
  39. All of the drugs are _____, especially to cats?
  40. What can be fatal if even a little bit gets administer IV to cats?
  41. What are the steps to performing regional nerve blocks?
    • locate the foramen
    • insert the needle bevel down (towards the bone)
    • aim to insert the needle just to or slightly into the canal
    • aspirate
    • rotate the needle 1/4 a turn
    • aspirate again
    • rotate the needle 1/4 a turn
    • aspirate the needle a third time to be sure you are not in a blood vessel
    • slowly inject
    • place a finger over the foramen for 20 - 30 seconds after withdrawing the needle
  42. What does the infraorbital nerve block anesthetize?
    • upper lip
    • nose
    • roof of nasal cavity
    • skiin ventral to the infraorbital foramen
    • maxillary incisors, canine, and first 2 premolars
  43. How do we do an infraorbital nerve block?
    • lift lip and palpate foramen
    • insert needle through buccacl mucosa where it forms a crease
    • direct needle (bevel down?) toward the floor of the foramen in a rostrocaudal direction, just at the foramen
    • aspirate and rotate three times
    • inject and hold pressure on foramen
  44. What does a palatine block/maxillary nerve block anesthetize?
    • maxillary 4th premolars
    • molars
    • hard tissue caudal to the maxillary 4th premolar (hard and soft palate)
  45. Where do we do the palatine block/maxillary nerve block?
    • visualize the midline of the palate and the palatal root of the 4th premolar
    • draw an imaginary line for each
    • halfway across the line is the opening of the major palatine foramen
  46. Should we enter the actual foramen for the palatine block?
    no because of large vessels in the foramen
  47. How do we find where to do the maxillary nerve block?
    with the patient's mouth open, palpate the notch at the rostral ventral aspect of the zygomatic arch as it meets the bone surrounding the last maxillary molar
  48. How do we do a maxillary nerve block?
    • insert the needle perpendicular to the horizonal line of the palate directly adjacent to the bone at the ventral border of the zygomatic arch
    • walk  the needle slightly cranially along the cranial side of the maxilla to a level just beyond the root tips of the last molar
    • aspirate 3 times
    • apply digital pressure 30 - 60 seconds
  49. Whats another name for the inferior alveolar foramen?
    mandibular block
  50. What does the inferior alveolar foramen nerve bloc, anesthetize?
    • blocks all teeth in the mandible
    • also blocks soft and hard tissues
  51. Where do we anesthetize for the mandibular block?
    located on the lingual surface of the mandible, halfway between the caudal curve of the mandible and the angular process
  52. What are the 2 different types of mandibular blocks can we do?
    extra-oral and intra-oral
  53. How do we do the extra-oral approach to the mandibular block?
    • clip and prep a small area at the angle of the mandible
    • slide your finger inside the mouth until you feel an indentation
    • from the outside, insert the needle through the skin until the needle hits the mandibular notch
    • aspirate three times and inject
  54. How do we do the intra-oral mandibulad block?
    • place the animal lateally so the side you want to block is down
    • palpate the foramen on the down side
    • direct the syringe across the tongue from the up side of the mouth
    • aspirate 3 times and inject
  55. What does the mental nerve block aneathetize?
    • 1st and 2nd premolars
    • canines
    • incisors
    • soft and hard tissues of the mandible rostral to the 2nd premolar
  56. How many foramens are there for the mental foramen block and which one do we use?
    there are 3 and we use the middle one
  57. How do we do a mental nerve block?
    • insert needle bevel down into the submucosa in a rostral to caudal direction and advance just to the entrance of the foramen
    • aspirate 3 times
  58. How long should we use post operative analgesia?
    3 -7 days