Local Anesthetics

[Yah-E]

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So it's lunch time and I'm bilaterally anesthetized right now. I'm starved and I can't even feel my tongue, lips or any sensation of my lower arch.

This morning, it was our Anesthesia II lab. My group (last quarter of the alpahbets) went today and performed mandibular blocks (IANB) on one another. Only one syncope classmate and no really any trauma stories to share. I did two IAFNs on two classmates and I did well.

So, for you D2s out there, have you injected yet? Any cool, funny and/or scary stories to share?

 

[ItsGavinC]

I'm so not excited about my classmates and I doing this on each other.

 

[DcS]

I know on my first IAN block on my partner (and the first shot i ever attempted), I hit his nerve directly and it shot an electric jolt down his jaw he jumped up. I laughed so hard. How's that for some good aim huh?!

 

[organic]

have you guys tried extra-oral infraorbital nerve injection yet ?

😀

 

[cusp of carabelli]

i did mine 2 weeks ago..it's totaly not bad. I did pretty good actually...1 ian block, an infiltration and a lingual nerve block. I guess the fact that it was right after our oral path test kinda made me numb to it though. hehehe...neways...the person who was injecting me did okay...except that she squirted some of the LA down my throat. LA is THE WORST TASTING THING on the face of the earth! i tried to wipe it off with a gauze but too late...couldn't get the taste out for hours. =oP The nitrous part of the session (before oral path test) was nice though...it's like getting a beer buzz w/o paying the $6...=op does anyone else have to do N2O? 😀

 

[bitecys]

We did our Anesthesia practical in May of our Freshman year. We had to do a local infilt, greater palatine, inferior alveolar. We also had the option of practicing a nasopalatine (if we would then let our partner do it on us), PSA, and a V2 block through the greater palatine into the fossa (the name of which now escapes me).

Anyway, to make a long story short...we only had one guy pass out and we had oral surg residents showing us how to do some of the more complicated ones. I wasn't a big fan of having my entire V2 numb...

This semester we are in our 2nd Anesthesia class and will be administering N2O and starting IVs in short order.

 

[DcS]

Originally posted by organic
have you guys tried extra-oral infraorbital nerve injection yet ?

😀

Hell no! We had the "option" of performing an intra-oral infraorbital block, but i'd be surprised if a school let students attempt an extra-oral iab. You'd have to be nuts.

 

[Yah-E]

Great posts everyone! The next round of anesthesia rotation, we will be performing a Maxillary Block via Great Palatine foramen approach (right through the great palatine foramen in the palate) and PSA block.

This round of rotation will be interesting and I expect a lot more syncope classmates and hematomas. PSA blocks are taught that it's not recommended due to the location of the target site near the pterygoid plexsus (a higher chances of positive aspiration and intravascular injections).

I can't imagine the discomfort to getting my palate poked over and over again because my classmate is trying to locate the great palatine foramen and then have a 25 gauge long needle go right into my pterygopalatine fossa (OUCH)!! 😱

We don't do Nitrous certificaiton or IV until 3rd or 4th year? Dont' you guys just love administering LA? It give you this sense of "hey, I'm a dentist" feeling!!



If you think extraoral infraorbital is crazy, then how about practicing extraoral mand. & max. blocks via the sigmoidal notch below the zygomatic process?

BTW, have any of you done Gow-Gates?

 

[drPheta]

My God. I have this gut feeling that when time comes for us to do this, we'll have at least one story.

Woo, I'm so not looking forward to this. Funny when my friends find out that our first patients to inject LA into are our classmates.

 

[organic]

Originally posted by DcS
Hell no! We had the "option" of performing an intra-oral infraorbital block, but i'd be surprised if a school let students attempt an extra-oral iab. You'd have to be nuts.

😕

as a dentist, we are supposed to know all kinds of techniques for numbing nerves related to oral cavity. What is so nuts about it? you made me remember those trauma surgeon residents who paged us at the midnight because they can only suture up to vermillion...they tremble at the thought of entering oral cavity.

 

[DcS]

Yeah I guess we should know all techniques, but my school doesn't feel like it's necessary for us to teach them all. Some I guess they feel will be used with so little frequency they don't make us perform them. When would a person use an extra-oral infraorbital unless the patient was completely unable to open their mouth? There are so many blocks in dentistry that overlap, and a majority of the time you will do those most practical.
I (along with most other dentists) would rather infiltrate then perform an ASA block. Mostly this is due to fear of hitting the eye, but that is hard to do with the orbital rim curving out. The ASA actually is very effective and requires less anesthetic than with supraperiostal injections. I still don't see the need to do an extra-oral. I'd be curious to see what % of dentists have actually done one of these. Maybe Dr. Jeff can enlighten us.



Yah-E we did a gow-gates.

 

[DrJeff]

Originally posted by DcS
I still don't see the need to do an extra-oral. I'd be curious to see what % of dentists have actually done one of these. Maybe Dr. Jeff can enlighten us.

The only times I've done extra oral injections were during my residency when as part of our Hospital ER coverage, the dental residents would suture facial lacerations. Let me tell you, after anesthetizing and then suturing an eyelid, everything we commonly do on a daily basis is simple Other than that aside from administering some IM injections to my dogs its all intra-oral for me. If you're an OMFS, you'll be doing a moderate amount of extra-oral injections especially if your doing trauma at your local hospital, or are doing facial plastic surgery at your office.

BTW, my first LA adimistering experience was on my wife (girlfriend at that time). When I was administering the PSA, I was scraping periosteum with the bevel side the entire way up 😱 Inspite of that, she still married me😍 😕

 

[Yah-E]

Dr. Jeff:

I can't believe she let you practice on her, BRAVE WOMAN! Bevel against the bone the entire time? WOW!😱

 

[DrJeff]

Originally posted by Yah-E
Dr. Jeff:

I can't believe she let you practice on her, BRAVE WOMAN! Bevel against the bone the entire time? WOW!😱

Yup, but about 2 minutes later, it was me in the chair, and her with the syringe 😱 Fortunately though she paid a little more attention to the direction of the bevel than I did😉 😍

 

[Yah-E]

Ahhhhhh...that's right you're both dentists! I, now, remember.

 

[aphistis]

Originally posted by Yah-E
Ahhhhhh...that's right you're both dentists! I, now, remember.

She's an ortho, as I recall...does that still count? 😉

 

[DrJeff]

Originally posted by aphistis
She's an ortho, as I recall...does that still count? 😉

Just remember Bill, all specialists are GP's first! Then the realize that they can't cut a prep to save their lives! 😉 😀

 

[Rob2005]

Sheesh, I'm jealous. Our school just has a
three hr session that has us give three different injections to each other. Then
they unleash us to use our patients as our guinea pigs.