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Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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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.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
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Parenteral Anesthetics: Overview01:24

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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 Surface, Infiltration, and Conduction Block Anesthesia01:30

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Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
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Local Anesthetics: Pharmacokinetics01:13

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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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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Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

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Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain.

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  • 1Former Graduate Student in Endodontics, The Ohio State University, Columbus, Ohio.

Anesthesia Progress
|April 4, 2022
PubMed
Summary
This summary is machine-generated.

A periodontal ligament (PDL) injection before palatal infiltration significantly reduced needle insertion and solution deposition pain. This technique offers a more comfortable dental experience by minimizing discomfort during local anesthesia administration.

Keywords:
InjectionInjection painIntraligamentaryLidocainePDLPalatal anesthesiaPeriodontal ligament

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Area of Science:

  • Dentistry
  • Anesthesiology
  • Pain Management

Background:

  • Palatal infiltration is often associated with significant needle insertion and solution deposition pain.
  • Minimizing pain during local anesthesia is crucial for patient comfort and acceptance of dental procedures.

Purpose of the Study:

  • To evaluate the effectiveness of a periodontal ligament (PDL) injection as an adjunct to reduce pain associated with palatal infiltration.
  • To compare pain levels between PDL injection with alternative palatal infiltration versus mock PDL injection with conventional palatal infiltration.

Main Methods:

  • A prospective randomized study involving 133 subjects.
  • Subjects received either a PDL injection with alternative palatal infiltration or a mock PDL injection with conventional palatal infiltration at separate appointments.
  • Pain was assessed using the Heft-Parker visual analog scale (VAS) for needle insertion and solution deposition.

Main Results:

  • The combination of PDL injection and alternative palatal infiltration resulted in significantly lower mean VAS pain ratings (P < .0001).
  • Moderate to severe pain incidence decreased dramatically from 65% to 1% for needle insertion and from 65% to 2% for solution deposition.

Conclusions:

  • Administering PDL anesthesia in the maxillary first molar's mid-palatal sulcus followed by alternative palatal infiltration significantly reduces pain.
  • This technique provides a more comfortable alternative to conventional palatal infiltration with a mock PDL injection.