Download Local Anesthetic Technique Handout 2009

Local Anesthesia Injection Technique
2009
Division of Oral & Maxillofacial Surgery
University of Minnesota
I.
Patient Preparation
a. Medical history and physical evaluation
b. Blood pressure and pulse assessment
c. Chair position
i. Supine
ii. Semisupine
d. Operator and Patient position
e. Record event in chart
II.
Site Preparation
a. Identify landmark
b. Dry mucosa with sponge
c. Apply topical anesthetic with cotton applicator
i. Use pressure on palatal injection
III.
Technique
a. Bevel orientation
b. Insert needle
c. Aspirate
d. Monitor injection rate
i. Position of the barrel of the syringe
ii. Slow injection (1mL/min)
e. Needle should not bend
f. Needle should not be inserted all the way to the hub
g. Replace needle cover with safe technique
IV.
Maxillary Injection Technique
a. Local Infiltration (supraperiosteal injection)
i. Injection site: Mucobuccal fold of target tooth
ii. 30 gauge needle
iii. Depth: A few millimeters
iv. Anesthetized: Tooth, periosteum, mucous membrane
b. Posterior Superior Alveolar N. Block (PSA)
i. Injection site: Height of the mucobuccal fold above the maxillary 2nd molar; 45
angle to the maxillary occlusal plane
ii. Depth: 16mm
iii. Anesthetized: All molars but 72% of mesiobuccal root of maxillary 1st molar
c. Middle Superior Alveolar N. Block
i. Injection site: Mucobuccal fold above the 2nd premolar
ii. Depth: A few millimeters
iii. Anesthetized: 1st and 2nd premolar and mesiobuccal root of maxillary 1st molar
d. Anterior Superior Alveolar N. Block (Intraorbital N. Block)
i. Injection site: Height of the mucobuccal fold over 1st premolar
ii. Depth: 16mm
iii. Anesthetized: Central incisal through canine, occasionally maxillary
premolars and mesiobuccal root of maxillary 1st molar
e. Nasopalatine N. Block
i. Injection site: Lateral to the incisive papillae
ii. Depth: 6 – 10mm
iii. 30 gauge needle
iv. Anesthetized: Anterior palatal (hard and soft tissues of mesial of 1st premolar
to the other side of mesial of 1st premolar)
f. Greater Palatine N. Block (Anterior Palatine Block)
i. Injection site: Halfway between the alveolar crest and the midline (2 nd and 3rd
molar area)
ii. Depth: Less than 10mm
iii. 30 gauge needle
iv. Anesthetized: Posterior portion of hard palate and overlying soft tissue to the
1st premolar and midline
g. Maxillary N. Block (V2 Block)
i. Greater palatine canal approach
ii. High tuberosity approach
V.
Mandibular Injection Technique
a. Inferior Alveolar N. Block (IAN)
b. Lingual N. Block
i. Injection site: The line of needle insertion is from the opposite mandibular
premolars
ii. 25 or 27 gauge needle, long
iii. Depth: 10 – 25mm; height of insertion is usually above the occlusal plane (6 –
10mm)
iv. Withdraw slightly and deposit remainder of carpule for lingual nerve anesthesia
v. Anesthetized: Pulp of the mandibular teeth to the midline, body of the
mandible, buccal mucoperiosteum and mucous membrane anterior to the
mandibular 1st molar, ipsilateral lower lip, anterior 2/3 of tongue
c. Long buccal N. block
i. Injection site: Height of the occlusal plane, posterior to the mandibular 3rd
molar into the soft tissue near the external oblique ridge
ii. Depth: 1 or 2mm
iii. Anesthetized: Periosteum, soft tissue buccal to the mandibular molars
d. Mental N. Block
i. Injection site: Between the mandibular premolars
ii. Depth: 5 – 6mm
iii. Anesthetized: Buccal mucous membrane anterior to the mental foramen to the
midline, lip and chin
e. “Gow-Gates” Mandibular Block (V3 Block)
i. Injection site: Height of injection; mesiopalatal cusp of maxillary
second molar.
Penetration; distal to the 2nd molar
ii. Depth: 25mm
iii. Anesthetized: Distribution of V3
f. “Vazirani Akinosi” Mandibular Block
i. Injection site: Mouth closed. Align the needle and syringe parallel to and along
the line of the maxillary 2nd and 3rd molar mucogingival junction; insertion of
needle to the soft tissue overlying the mesial border of the mandibular ramus
directly adjacent to the maxillary tuberosity at the height of the mucogingival
junction adjacent to the maxillary 3rd molar
ii. Depth: 25mm
iii. Anesthetized: Distribution of IAN, lingual N., mental N., and incisive N.