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Local Anesthesia (onset of anesthesia (diffusion to the site…

- - - - pH
        
        BH+
        
        acidic Ionized form
        
        can't pass through nerve membrane
        
        water soluble
        
        B
        
        Basic, unionized form
        
        can pass through nerve membrane
        
        lipid soluble
  - - - advantages
        
        longer duration
      - disadvantages
        
        slower onset
        
        not as safe
        
        3/4-1 carp for IA
        
        more technique sensitive
      - Duration of plural anesthesia
    - - advantages
        
        simple
        
        safe
        
        1/2 - 3/4 carp
        
        good hemostasis w/ vasoconstrictor
        
        faster onset
      - Disadvantages
        
        multiple injections for multiple teeth
        
        shorter duration
      - Duration of plural anesthesia
- - - - Change in dissociation equilibrium
        
        less anesthetic can enter the nerve
        
        decreased anesthetic effect
    - - an exaggerated CNS response to even gentle peripheral stimuli
- - - - vasoconstrictor
        
        60 min
        
        120 min
        
        1:100,000 or 1:200,000 epi
        
        plural: 1-1.5hrs
        
        soft tissue: 2-4hrs
        
        Septocaine, porcine, artisane, orabloc, ultracaine, septonest
    - - 3% plain
        
        30 min
        
        40 min
        
        plural: 20-40min
        
        soft tissue: 2-3 hrs
      - 2% vasoconstrictor
        
        90 min
        
        60 min
        
        1:20,000 levonordefrin
        
        plural: 1-1.5 hrs
        
        soft tissue: 3-5hrs
      - carbocaine, polocaine, isocline, scandonest, etc.
      - max: 3.0mg/lb or 400mg
    - - vasoconstrictor
        
        40 min
        
        240 min
        
        1:200,000 epi
        
        long acting by block injection only
        
        plural: 1.5-7hrs
        
        soft tissue: 5-12 hrs
        
        Marcaine, vivacaine
        
        max: 0.6mg/lb or 90mg
    - - plain
        
        8 min
        
        10 min
        
        not available in dental cartridges
        
        Pulpal: 5-10min
        
        Soft tissue: 1-2 hrs
        
        max: 2.0 mg/lb
      - vasoconstrictor
        
        60 min
        
        120 min
        
        1:100,000 or 1:50,000 epi
        
        Pulpal: 1-2hrs
        
        soft tissue: 3-5hrs
        
        max: 3.2mg/lb or 500mg
      - xylocaine, octocaine, lingospan, etc.
    - - vasoconstrictor (epi)
        
        50 min
        
        90 min
        
        Citanest forte
        
        plural: 1-1.5hrs
        
        soft tissue: 3-8hrs
      - plain
        
        10 min
        
        50 in
        
        Citanest
        
        plural: 40-60min*
        
        *only via block - infiltration is 5-10 min
        
        soft tissue: 2-3hrs
      - max: 4.0mg/lb or 600 mg
    - - sensitive patients usually not reactive to other amide agents
      - recommend patch testing by allergist
        
        Note: this is not entirely reliable
      - true allergy very rare
  - - - no longer available in the US in dental cartridges
      - Available in multi dose bottles
      - frequent cross-reactivity
- - - - physician consult recommended*
  - - - no interactions with serotonin re-uptake inhibitors (Paxil, Zoloft, Prozac)
- - - - pain messages
        
        slow conducting
        
        C fibers
    - - Vibration
        
        rapid conduction
        
        large A-beta fibers
        
        block C fiber pain stimulation by "closing the pain gate"