Carbocaine for Missed IAN Block

[tinna]

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Can anyone tell why carbocaine is used after missing nerve block with Lidocaine 2% with epi 1:100,000. In my opinion following could be the reason
1- It has low pKa so better ability to penetrate the nerve.
2- It does not have epi, so we can limit the quantity of epi.

Any other thoughts in mind.

 

[doctor-wanabe]

If you miss the nerve block with lido, then it's an issue of missing your mark-not the LA used. So, in that case, go for the Gow-Gates with lido.

 

[bigbadaboom]

epi is not the limiting factor in dental anesthetics. Giving 2% lidocaine or 3% mepivacaine will reach the toxicity level much faster than 1:100k epi.

 

[CMistry]

Was this a cardiac/hypertensive patient or any other concerns? Or are you simply speaking in general terms?

 

[Regmata]

It will diffuse through tissue a bit more, b/c there is no epi to hold it in place. If you are off the mark, you will have a better chance of the drug reaching the nerve. Whether or not it reaches the nerve in an efficacious quantity is another story.