To OMFS residents: Part One: On LA techniques

[fightingspirit]

When I was discussing techniques of local anesthesia with the chief OS resident here a stony brook, I suggested an ASA block along with a nasopalatine block for exo of teeth 9,10, & 11; I also suggested a V2 block for an upper quadrant multiple exo. The chief resident was against the ASA; his reasoning was that the infraorbital n is just too superior and hence too close to the inferior border of the orbital rim. He was also against the V2 block because the high tuberosity approach may result in a hematoma and the greater palatine approach may end up with retrobulbar anesthetic deposition or a needle break within the canal itself.

my questions:
Q1: If V2 blocks are that risky, y does malamed suggest them? Do u guys give V2 blocks frequently?

Q2: Malamed mentions that the palatine canal approach is safer/less risky & easier than the high tuberosity approach; do u guys agree with this? When u r doing ur V2 blocks, r u guys doing it by the high tuberosity or the palatine canal approach?

Q3: For exo 9,10, and 11, would u guys give field blocks for each individual tooth? Or just go ahead and give an ASA?

thanks guys....

FS

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[aphistis]

When I was discussing techniques of local anesthesia with the chief OS resident here a stony brook, I suggested an ASA block along with a nasopalatine block for exo of teeth 9,10, & 11; I also suggested a V2 block for an upper quadrant multiple exo. The chief resident was against the ASA; his reasoning was that the infraorbital n is just too superior and hence too close to the inferior border of the orbital rim. He was also against the V2 block because the high tuberosity approach may result in a hematoma and the greater palatine approach may end up with retrobulbar anesthetic deposition or a needle break within the canal itself.

my questions:
Q1: If V2 blocks are that risky, y does malamed suggest them? Do u guys give V2 blocks frequently?

Q2: Malamed mentions that the palatine canal approach is safer/less risky & easier than the high tuberosity approach; do u guys agree with this? When u r doing ur V2 blocks, r u guys doing it by the high tuberosity or the palatine canal approach?

Q3: For exo 9,10, and 11, would u guys give field blocks for each individual tooth? Or just go ahead and give an ASA?

thanks guys....

FS

I'm not OMFS, but I've done my fair share of dentoalveolar surgery so far.

Q1: I love V2 blocks, but only when they're indicated. To me, extracting 9/10/11 does not warrant a V2 block. Even after discussing the potential risks, you can convince a patient to agree to anything that results in fewer needlesticks, but numbing the entire hemimaxilla for 4-6 hours, for the procedure you indicated, strikes me as overkill. If I'm extracting four or more teeth spread throughout a quadrant, or if I'm doing a full-mouth extraction and I want to conserve local anesthetic, I start thinking about a V2 block.

Q2: I give mine through the palatine canal. I've never had a hematoma, but I'm not interested in an injection technique that gives me the risk of injecting intra-arterially. With the palatine canal approach, the risk of needle breakage is no worse than anywhere else. I've never heard of anyone getting a retrobulbar block from a V2; and besides, even if it *did* happen, what difference would it make how you approached?

Q3: I'd give one cartridge as an infraorbital/ASA on the left, half of a second one infiltrated over #8 to give a wider area of soft tissue anesthesia (and also to make sure I'm covered in case I have to raise a flap), and the other half as a nasopalatine. With respect to the OMFS resident who is surely much better at oral surgery than me, the risk of eye injury from an infraorbital injection is vanishingly tiny, and not even worth mentioning to the patient.

 

[gryffindor]

Like aphistis, I'm not even remotely close to an OMFS, but I'm still taking out teeth to pay the bills.

The only injections I have ever given for extractions in the maxillary are buccal and palatal infiltrations. Doesn't matter if I'm taking out a solid first molar or digging out an entire arch full of root tips or extracting 9, 10, and 11 at once. Everyone gets an infiltration because it is easy for me, I don't have to think or worry about any anatomy, and the patient will get predictably numb.

Isn't the nasopalatine block the one that hurts like no other?

 

[servitup]

i use ASA blocks for all of my Full mouths but none of my coresidents do. Patients tolerate the ASA block much better than multiple local infiltrations in that region in my opinion.

I give V2 rarely but when I do, I go through the foramen.