Local Anesthesia Injection Technique



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Local Anesthesia Injection Technique

2009


Division of Oral & Maxillofacial Surgery

University of Minnesota





  1. Patient Preparation

    1. Medical history and physical evaluation

    2. Blood pressure and pulse assessment

    3. Chair position

      1. Supine

      2. Semisupine

    4. Operator and Patient position

    5. Record event in chart




  1. Site Preparation

    1. Identify landmark

    2. Dry mucosa with sponge

    3. Apply topical anesthetic with cotton applicator

      1. Use pressure on palatal injection




  1. Technique

    1. Bevel orientation

    2. Insert needle

    3. Aspirate

    4. Monitor injection rate

      1. Position of the barrel of the syringe

      2. Slow injection (1mL/min)

    5. Needle should not bend

    6. Needle should not be inserted all the way to the hub

    7. Replace needle cover with safe technique




  1. Maxillary Injection Technique

    1. Local Infiltration (supraperiosteal injection)

      1. Injection site: Mucobuccal fold of target tooth

      2. 30 gauge needle

      3. Depth: A few millimeters

      4. Anesthetized: Tooth, periosteum, mucous membrane

    2. Posterior Superior Alveolar N. Block (PSA)

      1. Injection site: Height of the mucobuccal fold above the maxillary 2nd molar; 45 angle to the maxillary occlusal plane

      2. Depth: 16mm

      3. Anesthetized: All molars but 72% of mesiobuccal root of maxillary 1st molar

    3. Middle Superior Alveolar N. Block

      1. Injection site: Mucobuccal fold above the 2nd premolar

      2. Depth: A few millimeters

      3. Anesthetized: 1st and 2nd premolar and mesiobuccal root of maxillary 1st molar

    4. Anterior Superior Alveolar N. Block (Intraorbital N. Block)

      1. Injection site: Height of the mucobuccal fold over 1st premolar

      2. Depth: 16mm

      3. Anesthetized: Central incisal through canine, occasionally maxillary

premolars and mesiobuccal root of maxillary 1st molar

    1. Nasopalatine N. Block

      1. Injection site: Lateral to the incisive papillae

      2. Depth: 6 – 10mm

      3. 30 gauge needle

      4. Anesthetized: Anterior palatal (hard and soft tissues of mesial of 1st premolar to the other side of mesial of 1st premolar)

    2. Greater Palatine N. Block (Anterior Palatine Block)

      1. Injection site: Halfway between the alveolar crest and the midline (2nd and 3rd molar area)

      2. Depth: Less than 10mm

      3. 30 gauge needle

      4. Anesthetized: Posterior portion of hard palate and overlying soft tissue to the 1st premolar and midline

    3. Maxillary N. Block (V2 Block)

      1. Greater palatine canal approach

      2. High tuberosity approach




  1. Mandibular Injection Technique

    1. Inferior Alveolar N. Block (IAN)

    2. Lingual N. Block

      1. Injection site: The line of needle insertion is from the opposite mandibular premolars

      2. 25 or 27 gauge needle, long

      3. Depth: 10 – 25mm; height of insertion is usually above the occlusal plane (6 – 10mm)

      4. Withdraw slightly and deposit remainder of carpule for lingual nerve anesthesia

      5. Anesthetized: Pulp of the mandibular teeth to the midline, body of the mandible, buccal mucoperiosteum and mucous membrane anterior to the mandibular 1st molar, ipsilateral lower lip, anterior 2/3 of tongue

    3. Long buccal N. block

      1. Injection site: Height of the occlusal plane, posterior to the mandibular 3rd molar into the soft tissue near the external oblique ridge

      2. Depth: 1 or 2mm

      3. Anesthetized: Periosteum, soft tissue buccal to the mandibular molars

    4. Mental N. Block

      1. Injection site: Between the mandibular premolars

      2. Depth: 5 – 6mm

      3. Anesthetized: Buccal mucous membrane anterior to the mental foramen to the midline, lip and chin

    5. “Gow-Gates” Mandibular Block (V3 Block)

      1. Injection site: Height of injection; mesiopalatal cusp of maxillary second molar.

Penetration; distal to the 2nd molar

      1. Depth: 25mm

      2. Anesthetized: Distribution of V3

    1. “Vazirani Akinosi” Mandibular Block

      1. Injection site: Mouth closed. Align the needle and syringe parallel to and along the line of the maxillary 2nd and 3rd molar mucogingival junction; insertion of needle to the soft tissue overlying the mesial border of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the mucogingival junction adjacent to the maxillary 3rd molar

      2. Depth: 25mm

      3. Anesthetized: Distribution of IAN, lingual N., mental N., and incisive N.



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