Anesthesia pain : tips?

[FlyingSky]

Good evening
Most of my patients feel pain when I administrate local anesthesia.. Any advice?

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[txaggie03]

for soft tissue injections (IA, Mx infiltration, PSA, MSA, etc) grab their cheek. 'pull' the patient onto the needle instead of 'pushing' the needle into the patient. for GP blocks, squirt some liquid tetrafluoroethane on a cotton pellet, put the pellet where you want to inject, and inject directly beside or even through the pellet.

 

[Screwtape]

Dry the injection area and use topical anesthetic (benzocaine or whatever) and give it 5-10 minutes, know your anatomy so you don't have to move the needle inside the tissue too much, while you're inserting the needle very slowly inject a little anesthesia, when you're at the target area slowly inject the anesthetic (rate of a third carpule per 20 seconds). Some people like to "jiggle" the tissue during injection based off gate control theory. I don't jiggle and don't have problems. If doing palatal injections apply a fair amount of pressure on the tissue injection area with the handle end of the mirror while inserting and injecting anesthetic (gate control theory again). This is all i do and have minimal complaints. Looking forward to the other responses.

 

[sgv]

couple points: you could be injecting too fast. try slowing down. confuse the cns by either jiggling the lips or pressing adjacent to the hard or soft tissue sit of injection with the backend of the mirror. this activates pressure/vibration/touch receptors in addition to the slow pain receptors of your needle. if your workplace refrigerates the carpules, warm that sucker up before injecting it (i have zero idea if this has any scientific basis). inject ahead of the needle, bit by bit, as you enter the full depth so you're practically anesthetizing the tissue you're about to invade

 

[Myclinique]

Fast injection is really a good and helpful advise for you.

Dental braces

 

[DrJeff]

#1 - some topical - whether it actually works or has more of a psychological positive benefit is debatable. I use it for all of my injections though. I'll place my cotton tip applicator with topical on it, joke with the patient about it's taste for a moment, and then go wash my hands and glove up, so the topical is in their mouth for about 2 minutes

#2 - Use a 30 gauge needle whenever possible - the smaller the diameter of the needle, the less resistance it has, the more comfortable the patient will be

#3 - warm the anesthetic carpule up to above room temperature. The temperature contrast between your 98.6 degree patient and say your 72 degree anesthesia that's been sitting at room temperature can cause extra sensory responses upon the start of the injection

#4 - shake their lip/cheek/ whatever soft tissue part is near the injection site. This will help distract them, from what's going on at the injection site. And continue shaking through about 1/2 of the carpule being injected, and then start back up with the lip/cheek shaking just prior to finishing your injection and removing the needle

#5 - DEPOSIT THE ANESTHETIC SLOWLY!!!! It's not a race. Think about it, you're trying to get 1.7cc of solutuon that is acidic in nature into a space that is alkaline and doesn't have enough room typically for 1.7cc of solution. The slower you go (and I'll typically take at least 30 seconds, if not longer for a full carpule) the more the anesthetic that was initially deposited has had a chance to start working locally to lessen the discomfort as the tissues around the injection site are "stretched" as the 2nd half of the carpule is deposited. Comfort is key! And the running joke about this is "What's the difference between and oral surgeons injection technique and a GP's injection technique? ...... About 30 seconds!"

#6 - Just be confident! And this comes with experience. If you walk into the operatory and start off telling the patient that it won't be a big deal right from the get go, that plays a roll in their perception of how "comfortable" the injection is. Or if I have a patient ask me prior to the injection if it will hurt, my standard, quick, tongue and cheek answer is either "Do you want it to?" or "Not me!" It's just a little tension breaker I've found that works quite well as you help psychologically manage your patient through the injection process

 

[FlyingSky]

Thank you all so much!!!! I really really appreciate you taking the time to reply because the pain in my patients eyes is making me dislike that part and makes me want to take the needle out (I dont)

 

[bsp1013]

Always better to give than receive.

 

[bigstix808]

slower the better. warming the anesthetic helps too. i'll sometimes go in with some carbocaine first (better pH and less "burning"), then a couple min later use [choice] anesthetic and pt doesn't feel a thing.

 

[OhioDMD]

Nitrous oxide is your friend