Inferior Alveolar Nerve Block

Assuming that you’re doing this injection,
putting the barrel of your syringe in the corner of the mouth on the opposite side.
There are other ways of doing it, but this is the traditional way of doing it. So if
we go back to that diagram of the inferior alveolar nerve, exiting the brain in Seattle,
Washington, running down along the Pacific Coast and going back into bone in Los Angeles.
The traditional inferior alveolar nerve block, would be you boarding an airplane in Atlanta,
Georgia – which has to be Delta Airlines since the only airline really that flies out
of there. And you’re flying from Atlanta, Georgia to Los Angeles.
Essentially what you’re doing is putting the barrel of your syringe in the corner of
the mouth on the opposite side – Atlanta, Georgia – and you’re going straight across
the mouth, to your injection site. So this is one nice way of sort of visualizing
the traditional inferior alveolar nerve block. It doesn’t give you everything. It doesn’t
give you anesthesia of the soft tissue in the buccal fold that is distal to the metal
frame. So once we finish doing the inferior alveolar
nerve block, we then pull the syringe out using the same syringe, same needle. We have
a little bit of anesthetic left in the cartridge. And we insert the needle to the buccal fold.
Just distal and buccal to the last tooth in that, in that quadrant. Usually the second
or third molar. And we deposit the remaining content in the
cartridge. And this will give you soft tissue anesthesia anterior to that injection site,
down to the metal frame. So in theory, giving the IA block and the buccal nerve block should
give you profound anesthesia of the entire quadrant.
Unfortunately this injection is more painful than the inferior alveolar. Ahhh, you see
where it says VAS. VAS stands for visual analog scale. On a scale from zero to ten, zero being
you felt absolutely nothing, ten being the worst pain imaginable. This injection is three
– it varies – but anything from three or lower is comfortable.
Anything above three is increasingly more painful. And, the problem with this injection
is the moment your needle enters into the soft tissue, you’re on periosteum. And periosteum
is very sensitive. You can put topical on, to make the needle
puncture painless but there’s really no magic answer to making this injection painless.
Because if you start injecting local anesthetic as soon as you enter the soft tissue, it leaks
back out into the patient’s mouth. And I’ve never seen a patient who says that
they really love the taste of anesthetics. They are a very bitter tasting local-drug.


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