Complications of local anesthesia
Immediate complicationsLate complications
LocalSystemic
Immediate complications
Pain and BurningEdema
Visual disturbance
Failure
Blanching
Intravascular injection
Facial nerve paralysis
Fracture needle
Fracture cartridge
TMJ dislocation
Bleeding
Late complications
Pain at injection site
Hematoma
Trismus
Permanent paresthesia
Infection
Sloughing or ulceration
Self inflicted injury
Transmission of blood born infection
Systemic complications
Syncopy or faintingHepatitis and AIDs (blood borne disease transmittion )
Drug related complications
Allergic reaction
Overdose Intravascular injection
Drug interaction
Immediate pain and burning
Careless injectionDull need
Rapid deposition
IM injection
Barbs needle
Nerve injury
Irritating solution
Acidic PH of solution
Warmed solutionContaminated solution
Solution containing vasoconstrictor
Edema or swelling
causesTraumatic injection
Hemorrhage to soft tissue spacesIrritating solution
Allergic reaction
Prevention and treatment
Immediate care
Delayed careBlanching
At injection siteAt remote site
Visual disturbanceMaxillary injection
Mandibular injection
Blurred vision
Extra ocular muscle spasmTemporary blindness???????????
Failure to achieve or inadequate anesthesia
Incorrect techniqueInadequate solution / amount or concentration
inadequate vasoconstrictor
Infection
Anatomical variation
Anesthesia to mantle fiber only
Psychological problem
Intravascular injection
Incidence
Inferior alveolar block
Post. Sup. Alv. Block
Inf. Orb. Block
Mental n. block
Problem
Exaggerated Systemic effects of local anesthetic and vasoconstrictorIntravascular injection
Intravenous more dangerous than intra-arterial ???Management
Watch vital sign
Blood pressurePulse rate
Call for emergency
Facial nerve paralysis
Causes
Maxillary injection
Mandibular block
Cosmetic effectsLid reflex
Prevention and treatemetPain at injection site
Irritating or contaminated solutionExcessive force for deposition
Ulceration or sloughing
infection
Hematoma formation
Extra vascular effusion of blood out side blood vessels:Injury to blood vessels
Injury to muscle
Injury to venous plexus
Post. Sup. Block
Inf. Alv. Block
Infra orbit. block
Prevention
Correct technique
Short needle ?
Reduce penetration
Avoid change needle direction
Hematoma formation
Treatment
Pressure cold pack ?
Follow up observationHeat application ?
Antibiotic and analgesic
Trismus: limitation of mouth opening
Injury to the muscleInjury to condyle
InfectionTreatment:
Hot applicationMuscle relaxant
NSAIa
Chewing gum
Antibiotic
Permanent paresthesia
Nerve injury
Irritating wrong solution
Hemorrhage to nerveHigh concentration agents like articaine
Follow up every 2 weekReassurance
Record prognosis ?
Neurosurgical repair
Sloughing or ulceration at injection site
Local allergic reactionProlonged ischemia
Excessive solution or vasoconstrictorAntibiotic
Analgesic
mouth rinse
Infectionredness, pain, swelling and trismus
Contaminated solutionContaminated needle
Spread of infectionTreatment
Proper antibioticSurgical drainage
Follow up
Treat trismus
Syncope or faintingmost common complication of local anesthesia
Causes:
Vasovagal attack
Postural hypotension
hypoglycemia
Features:
Sweating, cold skin, numbness of extremities,tachycardiaHypotension and loss of consciousness
Treatment:
Supine positionNasal stimulation
Treat hypoglycemia
Allergic reaction
Type I reaction to methylparaben preservative or ester type local anesthetic (procaine) or even to vasoconstrictorAmide rarely cause allergisity
Reaction could be mild, moderate or sever
Patient identification
History and investigations (skin test?????)
Prevention and treatment:
Adrenaline
Antihistamine
hydrocortisone
Intravascular injection
Intra arterial
Blanching and visual disturbance
No treatment needed
Intravenous more sever reaction
CVS and CNSThese effect depend on:
Age, weight and type of L.A. concentration, vascularity and vasoconstrictor
Drug related complications
OverdoseAllergy
interaction