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Block injection

When I graduated 12 yrs ago I could give block injections that worked all the time. Now a days I can’t get a pt numb w/ a block to save my life. Does anyone one out there have any tips on what I can do?



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23 Answers

If my patient isn’t getting numb during an IA block that usually means I hit bone too early so I am not close enough to the nerve. To correct this I go higher up. Sometimes the needle almost seems to be just under the maxillary tuberosity its so high. I also move around the needle more anterior than the premolars occasionally to see if that helps. Or sometimes I need to go more posterior than the premolars. It just depends since everyones anatomy differs. Its trial and error. For a PSA be sure to angle inward and upward enough. This block is the hardest for me. Its really difficult to retract enough to see while the patient is open and get the right angle. If the dentist has to numb some patients for you maybe next time have him/her give you pointers or explain their technique. It happens to all of us sometimes, even dentists.

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I always use a 22 gauze to retract the check. I feel for the triangle of their jaw and insert a little superior to that. The syringe comes at the angle from the opposite side, pre molar region. I would use lidocaine then follow up with mapivicain. I then sit my patient up and wait 5 minutes and ask them to open/close several times to move the anesthetic around. Hope this helps! 🙂

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Septocaine or articane works great if u are comfortable using it. It diffuses really well and I never have had any issues with it.

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This is usually the result of aiming too low…go higher (more superior).

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Also probably doesn’t help that all my boss wants to use is Carbocaine.

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Carbo 3% is a poor choice in most cases, I agree! No vaso to keep it where you want it, more likely to end up giving the patient more anesthetic anyway. Can’t you ask your boss avout trying lido 2% and see how it works for you? I use septo in most cases and never have trouble getting patients numb, never had a problem afterwards either. Try using a cotton tip applicator to feel for the triangle for IA, I still do it every time to help visualize.

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I’m glad I’m not the only one. I’ll have to take a look at you tube. Visuals r usually a little easier for me.

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I had a few IA blocks fail on me. They do have a high fail rate to begin with just due to anatomy. Go higher or go Gow Gates is the way to go on that one. Carbocaine just doesn’t that the sustainability that we need for SRP. I like to use Lidocaine for the IA. It last long enough to get the job done. I have always had problems with the PSA but what helps me get my angles is the Minnesota re-tractor. It opens the field of view wide open to get your 45’s for the PSA.

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I know we have been told to not use articaine for mandibular injections because of high risk of parasthesia. The dentists that I work for have shown me research and statements from Malamed saying to use articaine and that there really isn’t a higher risk of parasthesia than if you use any other anesthetic. Since I started using articaine I’ve had pretty much 100% success with getting a patient numb. Also a helpful hint I got from one dentist is to use a short 22 gauge for the maxillary injections and use the same needle to give a stopper full on the IA. This is much more comfortable for the patient and will make the actual IA injection with the larger needle easier for them. Plus they will already be getting numb so you can readjust if you hit bone too soon and it won’t phase the patient!

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I agree, go a little more superior. Remember, everyones anatomy is different so each injection may be different as well. The way I do my my IA block (with a 90% success rate)I come in with my syringe over the opposite canine and once my needle is in, with only 15-20mm showing, and push my syringe to the corner of their mouth so now the syringe is over the 1st molar and place in the needle a little deeper until only 8mm is showing. I then aspirate and if negative, I inject the anesthetic, about 3/4 of the carp of Septo 1:100 epi. Hope this helps! 🙂

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I meant a 2×2 square gauze (for traction when retracting cheek).

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I’ve never had them open and close. I’ll have to try that next time. It seems no matter what I do I always hit below the target area and have to have my boss come in and give another. It’s very frustrating.

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If using the Gow Gates method it is best if the patient can leave there mouth open wide for several minutes following injection.

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What a great question. I talk to a lot of hygienist and a couple of docs who have the same problem. Something that I use as a guide is the pano if its available. Look at the location of the nerve. If its not available I usually go a little high (above my thumb)if I hit to soon I swing around (towards the other side). If you need a visual review try youtube.

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Anyone have any good resources for reviewing anesthesia specifically with knowing where to aim? I can never find youtube videos that actually show anything. I second guess myself a lot because everyones anatomy is so different.

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If the pt is missing their molars, or have their thirds I can’t do an IA. :-/

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If I know a patient is hard to get or keep numb; I use Lidocaine 2% followed up by Marcaine. I have had great results.

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I automatically administer Gow Gates for right side due to the positioning and it hasn’t yet not worked for me. I also have only been practicing for a little over a year.

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I always look for landmarks. Giving the IA, I only use Lidocaine, look for the pterygoid raphe I usually aim right underneath that. If the landmark is not there make sure in right over the premolars on the other side. Say your giving a lower left IA, make sure your syringe is directly above the contact of #28,29.
If they don’t have their 2nd premolars then aim in the same area. Works 9 times out of 10.

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Perfect animation video
http://youtu.be/hOVtwtC6pck

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There are a lot of great tips here, my only concern is septocaine for an IA, as it has been my understanding that parasthesia risk is greater with septo. I always use lidocaine with a next to zero fail rate and profound anesthesia.

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Lots of these questions can be answered in a newer text on LA by DHs for DHs- we need our own answers as DHs and we need them clearly answered! See the following info on the text at http://www.elsevier.com/books/local-anesthesia-for-the-dental-hygienist/logothetis/978-0-323-07371-4

You can go inside the text and see all the wonderful charts and figures and real-life clinical photos. See what to do and then what not to do.

I am a contributor to the text since I felt I had to give back to the DH profession and make pain control standard for DH care and make it right for us. Enjoy!!! Margaret J. Fehrenbach, RDH, MS

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I wish I could add a photo. I usually have a pretty good success rate with IA injections. I have always felt like people make too much out of the correct landmark to inject. I’ve watched all of the videos on YouTube and the way they explain on how to find the spot is so confusing! I have always felt like it’s an obvious bullseye when you look in the mouth. When you look at the pterygomandibular raphe it makes an arch, exactly halfway up that arch is where it starts to curve, if you relax the cheek a little you will notice an indention or dimple right in that spot. That is your bullseye. I initially insert while the syringe is placed over the anteriors but only insert the needle about 4mm then immediately swing over to the bicuspids and proceed, if I hit bone too early I swing back over and retract slightly then go in a couple more mm then swing back over. You should be dead on. If you do not hit bone at this point you went to far in initially before swinging over. Ugh I wish I had the ability to post pics!!.

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