anesthesia!

[mfdope]

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[Vapor1122]

Inject slowly. Seriously, the anesthesia is likely the most important thing to a lot of patients, so it pays to spend the two minutes on the injection rather than trying to rush through it. I haven't had a patient yet complain of a painful injection, and actually had a number of them tell me that I gave them the best they've ever had, all because of that.

Also, if you're going to use topical, thoroughly dry the mucosa with some gauze before applying it.

 

[SeattleRDH]

Before doing the IA warn the patient that they might feel a "zing" in their tongue (due to the lingual nerve) and that it's normal.

Always check the expiration date on your anesthetic (don't expect the assistant to have done so).

After rinsing the topical ask the patient if they want another rinse. Many people will want one (topical tastes icky!).

Try to get pina colada topical, it tastes the best.

 

[cybermech]

Before doing the IA warn the patient that they might feel a "zing" in their tongue (due to the lingual nerve) and that it's normal.

Always check the expiration date on your anesthetic (don't expect the assistant to have done so).

After rinsing the topical ask the patient if they want another rinse. Many people will want one (topical tastes icky!).

Try to get pina colada topical, it tastes the best.

I hear mixed things about whether or not to tell the patient about what exactly they're going to be feeling when you start to express the LA. Is it better to just reassure that patient that you're going to try to make it as painless as possible and just give it, or tell them exactly how it should feel?

I have no experience... our LA session is in January.

 

[SeattleRDH]

I hear mixed things about whether or not to tell the patient about what exactly they're going to be feeling when you start to express the LA. Is it better to just reassure that patient that you're going to try to make it as painless as possible and just give it, or tell them exactly how it should feel?

I have no experience... our LA session is in January.

Though rare, it only takes one time of having a patient jump while you have a needle in their tissue to tell them about the lingual nerve. It's not the anesthetic being expressed that causes this "zing," it's the chance that the needle activates the lingual nerve as you pass it towards the IA.
It's not really a painful sensation but it can be surprising.

I wouldn't get into describing the pain factor when it comes to administering anesthetic unless the patient seems really apprehensive. Sometimes it helps to talk about it beforehand. Tell them why placing topical is going to help them not feel the initial "pinch." I also explain (to the apprehensive patient) how the slower I go, the less they feel, so "lets just take a deep breath and think about drinking pina coladas on the beach far away from here" (another reason why I like pina colada flavored topical.

Sometimes injections are going to hurt (can you say palatals?) but if you convey to your patient that you really care about their comfort they will forgive you for those painful ones (and refer their friends to your practice!).

 

[NAVY DDS 2010]

Sometimes injections are going to hurt (can you say palatals?) but if you convey to your patient that you really care about their comfort they will forgive you for those painful ones (and refer their friends to your practice!).

If you spend a few seconds making sure you are injecting directly over the greater palatine foramen and you slowly administer the anesthesia, it can be a fairly painless injection. Now, I haven't found a good technique to avoid the pain of the nasopalatine injection, yet.

Before you give your first injections, make sure to review anatomy. It helps if you can check out skull of two and a couple cotton tip applicators to practice with so you can orient yourself within the mouth.

Next, just enjoy yourself. Remember this, be the second of the two partners to give the injections. That way you have leverage over your partner for him/her to make sure are careful and not be painful in their attempts to numb you up. Paybacks can be hell. You could always do bilateral Gow Gates and Infraorbital nerve blocks with bupivicaine if necessary. Infraorbital isn't painful, just very annoying having your lower eyelid and side of your nose numb for a long period of time.

 

[drhobie7]

don't forget to aspirate before injecting

 

[flapaTron]

don't forget to aspirate before injecting

HAhah

 

[ItsGavinC]

Inject slowly. Seriously, the anesthesia is likely the most important thing to a lot of patients, so it pays to spend the two minutes on the injection rather than trying to rush through it. I haven't had a patient yet complain of a painful injection, and actually had a number of them tell me that I gave them the best they've ever had, all because of that.

Excellent advice. I inject a full carpule in about 45-60 seconds. The first 10 seconds is comprised of me injecting a tiny bit, then waiting 3-4 seconds, then another tiny bit, then waiting again. Then I go slowly and consistently. As a nervous dental student, this WILL instill confidence in your patients when you treat them. It will do wonders for your confidence.

Keep in mind that I do this on 3 and 4 year olds. When I am done treating them the vast majority of them ask me when they are going to get a shot.

 

[ItsGavinC]

don't forget to aspirate before injecting

Yeah, I probably should do that, but it's been 5 years since I have. 😀

 

[yappy]

Would you feel bad if you found you were in a vein and gave the medication IV on accident?

 

[armorshell]

Would you feel bad if you found you were in a vein and gave the medication IV on accident?

There's actually an ongoing debate in the dental anesthesia community of whether or not aspirating during dental injections actually prevents you from delivering meds IV.

As an aside, even when you do aspirate there's about a 5% rate of IV injection. Usually I don't feel too bad since the morbidity of an IV injection of a small amount of local anesthetic with epi is incredibly minor, but sometimes the "adrenaline rush" freaks the patients out a bit.

 

[drhobie7]

There's actually an ongoing debate in the dental anesthesia community of whether or not aspirating during dental injections actually prevents you from delivering meds IV.

As an aside, even when you do aspirate there's about a 5% rate of IV injection. Usually I don't feel too bad since the morbidity of an IV injection of a small amount of local anesthetic with epi is incredibly minor, but sometimes the "adrenaline rush" freaks the patients out a bit.

Ah, interesting. I've heard the argument about the bevel being against the vessel wall. I agree, it's not of much consequence. I do it just as much to ensure the anesthetic is extravascular and will get the pt numb. Otherwise I'm just wasting lidocaine.

 

[armorshell]

Ah, interesting. I've heard the argument about the bevel being against the vessel wall. I agree, it's not of much consequence. I do it just as much to ensure the anesthetic is extravascular and will get the pt numb. Otherwise I'm just wasting lidocaine.

Most of the arguments I've heard are that trying to aspirate and maintain a steady position one handed doesn't tend to work that well and your needle tip can deviate pretty radically while aspirating. If this were true (I don't believe it's been evaluated) you're likely not aspirating and injecting in the same places.

Supposedly things like the new self-aspirating syringes are supposed to address this, but again, no real evidence basis. I aspirate on IANB, lingual, mental, PSA, V2, V3 blocks only and mostly for medico-legal reasons should anything go wrong.

 

[ItsGavinC]

Would you feel bad if you found you were in a vein and gave the medication IV on accident?

Short answer: no.

Longer answer:

1) Aspirating doesn't prevent you from delivering IV.

2) As was mentioned, aspirating in one area doesn't mean that's the area you are actually injecting into (partial reasoning for #1)

3) Delivering IV isn't going to do anything other than not get the patient numb like you want them to be.

 

[cybermech]

Short answer: no.

Longer answer:

1) Aspirating doesn't prevent you from delivering IV.

2) As was mentioned, aspirating in one area doesn't mean that's the area you are actually injecting into (partial reasoning for #1)

3) Delivering IV isn't going to do anything other than not get the patient numb like you want them to be.

At least if you go slowly, I'm sure you'll start to see classic CNS S/S. Man, I am having cold-sweat about my LA session next year. Need to find a skillful partner. LOL