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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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How Effective Is Supplemental Intraseptal Anesthesia in Patients with Symptomatic Irreversible Pulpitis?

Stephen Webster1, Melissa Drum1, Al Reader1

  • 1Division of Endodontics, The Ohio State University, Columbus, Ohio.

Journal of Endodontics
|September 25, 2016
PubMed
Summary

Supplemental intraseptal injections showed limited success (29%) in achieving profound anesthesia for endodontic treatment when the inferior alveolar nerve block failed. This technique is not yet predictable for emergency dental pain management.

Keywords:
Inferior alveolar nerve blockintraseptal anesthesiasymptomatic irreversible pulpitis

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Area of Science:

  • Dentistry
  • Endodontics
  • Anesthesiology

Background:

  • Intraseptal injections are successful in various dental procedures.
  • Limited data exists on intraseptal injections during endodontic treatment.

Purpose of the Study:

  • To evaluate the anesthetic efficacy of supplemental intraseptal injections.
  • To assess efficacy in mandibular posterior teeth with symptomatic irreversible pulpitis.
  • To determine efficacy when the inferior alveolar nerve block fails.

Main Methods:

  • 100 patients with symptomatic irreversible pulpitis in mandibular posterior teeth were enrolled.
  • After a failed inferior alveolar nerve block, supplemental intraseptal injections were administered.
  • Success was defined as pain control during endodontic access and instrumentation.

Main Results:

  • The inferior alveolar nerve block succeeded in 25% of patients.
  • Supplemental intraseptal injections achieved success in 29% of patients.

Conclusions:

  • Supplemental intraseptal injections provided profound pulpal anesthesia in only 29% of cases.
  • This technique does not offer predictable anesthesia for emergency endodontic treatment.
  • Further research is needed to improve anesthetic success rates for irreversible pulpitis.