In modern medicine, there are many ways to anesthetize. One of them is conduction anesthesia. The method consists in blocking the nerve transmission in the place of the human body where the surgery will be performed. The operation site is completely anesthetized and immobilized.
What is the patient experiencing
During this procedure, patients may feel different. When a needle is punctured, most often a person feels a slight pain or slight discomfort. In the area where the anesthetic is administered, bursting, heaviness, fever are sometimes felt at the time of its administration. If everything happens correctly, then the discomfort disappears after a few seconds.
During surgery, the patient is in clear consciousness, hears everything and sees, but does not feel pain at all. If the patient wants to sleep or is very anxious, conduction anesthesia is combined with sedation.
Technique
Conduction anesthesia blocks a nerve or a group of nerves through which a pain impulse is transmitted from the place where the operation is performed to the brain. The brain processes this impulse and returns to us in the form of a painful sensation. Anesthesia occurs in the area where the nerve was blocked.
Peripheral anesthesia is done as follows: a local anesthetic solution is injected into the place where the nerve to be blocked is located. One or more injections may be given. For the drug to work, it should be administered very close to the nerve, literally a few tenths of a millimeter from it. If you enter the anesthetic a little further, then anesthesia will not work, and during the operation, the person will be hurt. In this case, another type of anesthesia is used. When an anesthetic drug gets directly into the nerve, this is fraught with the development of a complication such as neuropathy.
In which cases is such anesthesia used
The use of PA on all parts of the body, unfortunately, is impossible. This is due to the anatomical features of the human body. But still, the list of operations in which they use a nerve block is not so small:
- various operations in somatology;
- hernia removal (femoral, inguinal);
- some surgical interventions for diseases of the genital organs;
- surgical treatment of the thyroid gland;
- quite complex operations performed by specialists on the carotid arteries.
This is not a complete list of cases in which an operation is performed using this type of anesthesia.
Complications of conduction anesthesia
The most serious complications during this type of anesthesia are considered an adverse reaction to an anesthetic drug or the development of neuropathy. In this case, the person begins an allergic reaction. Basically, this problem happens through the fault of doctors when they inject the solution into a blood vessel.
Symptoms of the reaction:
- cardiac arrhythmia;
- a sharp weakening of the body;
- loss of consciousness.
An allergic reaction is very rare, not more often than one case per 50,000 anesthesia.
Neuropathy occurs when a nerve is damaged or a violation of its activity occurs. With such a violation after conduction anesthesia, pain, numbness, and a feeling as if creeps crawl under the skin are felt. But there is no need to be afraid of the PA. After all, complications occur only in 1% of cases, and the health of a damaged nerve is restored within a few months, in rare cases - up to a year. In addition, recently emerging new technologies allow the appearance of such complications to be minimized.
The use of conductive anesthesia in dentistry
Since complications in this case are not common, conduction anesthesia in dentistry takes first place. A strong PA can anesthetize the area of ​​surgery for a long time (6-8 hours), and less severe anesthesia is used for surgical interventions.
For the lower and upper jaws, separate types of anesthesia are used. For example, to anesthetize the lower jaw, the intraoral and apodactyl method is used. In the first case, the doctor finds the puncture site, in the second case, anesthesia is administered near the extreme molar.
If it is necessary to deprive the upper jaw of sensitivity, then infraorbital anesthesia is done, in which the anesthetic is injected under the eyeball, or tubercular (the solution is injected into the tubercle of the upper jaw). This technique of conduction anesthesia is considered the most correct. Every experienced doctor knows this, and he should do just that.
When PA is used
Conduction anesthesia in dentistry is practiced in those cases when it is necessary to conduct a comprehensive surgical intervention. Quite often, such anesthesia is carried out when it is necessary to cut the gum when removing the tooth. The cheek in this case completely loses sensitivity.
This method of anesthesia allows you to completely block the nerve trunk, which leads to persistent analgesia during any manipulations in dentistry.
Indications and contraindications
Anesthesia in dentistry using conduction anesthesia for surgical procedures is carried out in the following cases:
- extraction of teeth or roots remaining from them;
- if mucosal inflammation is detected;
- if the tooth erupted incorrectly, then in this case they resort to this procedure;
- some people tolerate anesthesia very poorly, so the doctor decides to use such anesthesia, so the treatment becomes less dangerous;
- in the treatment of complex caries.
To protect the patient from complications and provide effective treatment, before choosing an anesthesia method, the doctor must be sure that the person has no contraindications to him. They may be as follows:
- if a person is allergic to drugs that are used for conduction anesthesia;
- in the presence of infectious diseases in the tissues of the face or in the oral cavity;
- if there is a change in the topography of individual sites, for example, when for some reason (surgery, injury) there was a violation of the transmission of nerve impulses;
- this method of pain relief is not recommended for children under 12 years of age;
- when the patient is very excited;
- conduction anesthesia is not used in the case of people with whom it is not possible to establish contact, for example, this applies to patients suffering from congenital deafness;
- In no case should PA be given to people who have septicopyemia (a type of sepsis), a disease characterized by multiple purulent rashes on the skin.
There are also contraindications against this kind of pain relief, which are relative. With such indications there is no categorical prohibition, but the specialist must eliminate them, if possible, or take into account that complications may arise. As a rule, such contraindications are quite rare:
- long operation;
- the patient is in a state of shock;
- excessive development of subcutaneous fat.
Types of conduction anesthesia
In total, there are two varieties of such anesthesia: central and peripheral. In the first case, nerve pain occurs in the lower or upper jaw. In the second case, anesthesia is also divided into several subspecies, it all depends on where the drug is administered. Peripheral anesthesia can be mental, infraorbital, incisive, etc. Conduction anesthesia of the extremities is known as regional. As a rule, it is done when a person needs to perform a simple operation on a specific part of the body.
PA of the lower jaw
Conducting anesthesia on the lower jaw is done in a mandibular way. In order to administer a local anesthetic, the patient needs to open his mouth wide. The doctor makes a puncture to the place where the border of the lower and middle pterygo-maxillary folds is located. The syringe should be parallel to the opposite premolar. Then the needle is inserted into the gum tissue, the doctor brings it to the bone itself and begins the process of drug administration, however, not all, but only 50% is administered, the remaining 50% is injected from the other side. After the procedure, the lingual and alveolar nerve is blocked. Fangs, molars, premolars and the mucous membrane, which is located around them, are also anesthetized. In addition, numbness of some areas of the tongue and lower lip occurs.
In the case of torus anesthesia from the cheek, additional pain relief is performed .
With mental anesthesia, the drug can be administered in two ways: extraoral and intraoral. In this case, numbness of the lower jaw arch occurs, while fangs, lower incisors, alveolar bone, chin, lower lip are anesthetized.
PA maxilla
Conduction anesthesia of the upper jaw is done in several ways.
The use of the infraorbital method allows you to “freeze” the frontal zone. In addition to teeth, the lower eyelid, the skin on the infraorbital area, the walls of the maxillary bone are anesthetized. The effect of anesthesia is felt on one side of the nose.
With the incisive method, a blockade of the nasal palate is observed. Thanks to this procedure, there is a “freezing” of the palate, fangs and teeth, which are located between them.
The tubercular method helps not to feel pain in the mucous membranes, maxillary sinuses, molars located on the upper jaw.
In the case of palatine anesthesia, from the side where the drug was administered, numbness of the area from the canine to the extreme molar occurs.
Advantages and disadvantages
Like other types of anesthesia, conduction anesthesia has its advantages and disadvantages. We list the advantages:
- you can limit yourself to a small number of injections, in most cases just one;
- due to the high concentration of the anesthetic drug, “freezing” lasts a long time;
- no need to administer a lot of medicine;
- thanks to different methods of PA, the drug can be administered away from the source of infection;
- in the place where the operation is performed, the gum does not deform;
- the procedure decreases salivation.
The disadvantages or disadvantages of this kind of anesthesia include the following:
- the technique of anesthesia is quite complicated;
- if a blood vessel is accidentally touched during a puncture, a hematoma may form in this place.
These shortcomings are considered relative, it all depends on how experienced the doctor is.
Safety and efficacy
Conduction anesthesia in dentistry is carried out using drugs placed in special ampoules (carpules). This method helps to properly dose the medicine, excluding the excess of the injected volume, an antiseptic is observed.
Due to the fact that the carpula is equipped with a very thin needle, the patient does not feel severe pain when they make a puncture. You can also anesthetize the venue with a special gel or spray.
Some clinics have devices that help determine the location of the nerve. Thanks to them, the doctor controls the introduction of the needle, which eliminates nerve injury and the occurrence of complications after PA. Ultrasonic testing can also be used.
How is the procedure for pain relief in children and pregnant women
Dental problems in pregnant women are quite common. A fetus that develops needs a large amount of calcium, which it takes from the mother's body. In this case, the teeth of the pregnant woman may suffer. Therefore, expectant mothers are frequent visitors to dental offices. Conducted anesthesia is given to women in position only when complex manipulation is necessary, for example, with multiple damage to the teeth, with severe caries, or when it is necessary to remove a bad tooth.
Usually, “Lidocaine” is used as an anesthetic. This is due to the fact that this drug is considered an effective pain medication, it is quickly excreted from the human body, is not harmful to either the mother or her unborn child. A drug such as Ketamine cannot be used in early pregnancy, because it increases the tone of the uterus, and can cause a miscarriage. If the expectant mother is tormented by severe pain, then in this case, you can use Promedol. This drug is an excellent pain reliever and not as dangerous as Ketamine.
Conduction anesthesia in pediatric dentistry, if the child is less than three years old, is used very rarely. Dental treatment in young children is different from how it occurs in adults. This is because the structure of the jaws in children is not the same as in adults.