Complications of Local Anesthesia

Dr. Maged A Omar

•Any deviation from normally expected pattern during or following the securing of regional anesthesia

Complications

• Mucosal irritation or tissue reactions due to the solution• Pain on injection• Burning on injection• Lip trauma• Prolonged impairment of sensations• Hematoma• Trismus• Facial paralysis• Visual disturbance• Broken needle• Gagging

Local Complications

• Mucosal irritation due to topical anesthesia

• Sloughing of palatal mucosa (delayed)

• Blanching of peripheral tissues supplied by artery

• Patient relaxation

Pain on Injection Lowered by :

• Topical anesthesia

• Stretching of mucosa

• Apprehensive patient position on the dental chair

Pain on Injection

• Slow injection

Pain on Injection Lowered by :

• Warmed solution

• Sharp needle

• Reasonable quantities

• Touching the nerve• Contaminated solution• Subperiosteal injection• Intramuscular injection• Injection against resistance• Too rapid injection• Cold solution

Pain on InjectionCauses:

• Touching the nerve

Pain on InjectionCauses:

• Contaminated solution

Pain on InjectionCauses:

•Subperiosteal injection

Pain on InjectionCauses:

• Intramuscular injection

Pain on InjectionCauses:

• Injection against resistance

Pain on InjectionCauses:

• Too rapid injection

Pain on InjectionCauses:

• Cold solution

Pain on InjectionCauses:

• Acidic preservative

• Immersion of sterilizing solution seeping into the cartridge

Burning on InjectionCauses:

Oral Surgery

• Lip chewing

Lip Trauma

• Prevented by cotton role in the labial vestibule

Lip Trauma

Prolonged impairment of sensations• Prolonged anesthesia• Paresthesia (tingling, burning)• Hyperesthesia ( sensitivity to stimuli)Causes• Hemorrhage within the nerve sheath• Impinging on the nerve trunk• Infection close to the nerve• Contaminated solution (e.g. alcohol)

Trismus

• Limited mouth opening (after 1-6 days)

Causes• Trauma to medial pterygoid muscle• Hemorrhage and hematoma

Treatment• Symptomatic• In severe cases; forcible opening exercises ,sometimes under GA

Trismus

Hematoma• Most commonly in posterior superior alveolar block

Facial paralysis

Facial paralysis

Facial paralysis

Visual Disturbance

Visual Disturbance

Broken needles• When using 27 gauge needle• Bending needle• Inserting needle to its hub• Major changes in position of the needle during administration• Unexpected movement of the patient

Broken needles

Broken needles

Broken needles

Broken needles

Gagging