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Anesthesia/Injections

 Notes contributed by Amy from Augusta, GA. MCG graduate 2005

I.                     Trigeminal Nerve-Maxillary Division

A.      5^th Cranial Nerve

B.     Sensory in nature

C.     Enters the skull through the Rotundum

D.     Branches include the infraorbital, nasopalatine, & greater palatine nerves

1.      Facial branches:  Infraorbital, anterior superior, middle superior, & posterior superior

2.      Lingual branches:

·         Nasopalatine nerve enters through the incisive foramen

·         Greater palatine nerve enters through the greater palatine foramen

II.                   Nerve Block vs. Infiltration

A.      Nerve block- deposition of anesthesia close to a main nerve trunk, often at some distance from the treatment area

-anesthetizes a larger area than other injection types

-good choice when scaling a sextant or quadrant

B.     Infiltration- anesthesia is placed more closely to terminal ends of nerve f

fibers in immediate area to be treated

*NOTE: There is a good diagram of the mouth, nerves, & teeth in Wilkins ( I would put a page #, but I might not have the same edition as some of you)

III.                  Infraorbital Nerve block (enters through infraorbital foramen)

A.      Anesthetizes

1.      max. ant, premolars, & mesiobuccal root of 1^st permanent molar (includes facial tissue of these teeth also)

2.      upper lip, lower eyelid, and side of nose

B.     Include Middle superior & Anterior superior

IV.                Anterior Superior Alveolar Nerve Block (ASA)

A.      Anesthetizes

1.      Max. anteriors

2.      Facial gingiva of max. anteriors

V.                  Middle Superior Alveolar Nerve Block (MSA)

A.      Anesthetizes

1.      Max. premolars & mesiobuccal root of max. 1^st permanent molar

2.      buccal gingiva of teeth mentioned above

VI.                Posterior Superior Alveolar Nerve Block (PSA)

A.      Anesthetizes

1.      max. molar except for MB root of 1^st molar

2.      buccal gingiva of the teeth mentioned above

VII.               Greater Palatine Nerve Block (GP) ~soft tissue

A.      Anesthetizes

1.      palatal mucosa to the midline

2.      lingual gingiva of max. post. Teeth

VIII.             Nasopalative Nerve Block (NP) ~soft tissue

A.      Anesthetizes

1.      lingual gingival of max. ant. Teeth

2.      palatal mucosa of premaxilla

IX.                Trigeminal Nerve- Mandibular Division

A.      Largest division of the trigeminal division

B.     Exits cranium through the foramen Ovale

C.     Divides into lingual nerve and inferior alveolar nerve

D.     Inferior alveolar nerve travels through mandibular canal and further divides into incisive and mental nerves.

X.                  Mandibular Nerve Block (inferior alveolar & lingual blocks) ~used most often

A.      Anesthetizes (1-4 are inferior, 5-7 are lingual)

1.      mand. teeth to the midline

2.      facial gingiva of mand. ant. & premolars

3.      chin

4.      lower lip on one side

5.      lingual gingival of mand. teeth to midline

6.      floor of mouth

7.      ant. 2/3 of tongue

B.     Inferior alveolar block anesthetizes areas innervated by inferior alveolar, incisive & mental nerves.

XI.                Buccal Nerve Block (Long buccal)

A.      Anesthetizes

1.      Facial gingiva of mand. molars

2.      Skin of cheek

XII.               Mental Nerve Block ~soft tissue

A.      Anesthetizes

1.      facial gingiva of mand. ant. & 1^st premolar

2.      skin of chin & lower lip

XIII.             Incisive Nerve Block

A.      Anesthetizes

1.      mand. 2^nd premolar anterior to central

2.      facial soft tissue from mental foramen to midline

3.      lower lip & chin

Local Anesthetics

Ester- metabolized in plasma

Amide- metabolized in the liver

Local Anesthetic Cartridge contents:

Amide- blocks the transfer of ions across the nerve membrane, stops transmission of pain

Vasocostrictor- constrict blood vessels to offset vasodilation

Antioxidant- preservative for vasoconstrictor

Sterile Water-dilutent

Sodium Chloride- creates an isotonic match with the body

Amide Local Anesthetics

- Lidocaine (Xylocaine) is most widely used

- When a vasoconstrictor is contraindicated, drug of choice is Mepivocaine (Carbocaine)

- Long-lasting analgesic is Bupivacaine~ has a delayed onset of action, extended period of analgesia for postcare pain management

Vasoconstictor (most commonly found in anesthetics) – Epinephrine & Levonordefrin

Max. recommended dose of vasoconstrictor (# of cartridges)

Healthy patient:  10 catridges  Epinephrine (1:100,000)    Levonordefrin (1:20,000)

Medically Compromised:  2 cartridges  Epi (1:100,000)   Lev (1:20,000)

There is 1.8 mL of solution in a carpule of local anesthesia

Purpose of Aspiration- to deteremine if the tip of the needle is in a blood vessel

Disclaimer: These notes were copied and pasted from files sent to me by Andrea.  They have not been reviewed for errors. You are responsible for checking out the information to verify the accuracy. This site, Amy Nieves and Amy who contributed these notes are not responsible for typographical errors.

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