POSITIVE ASPIRATION AND ITS SIGNIFICANCE DURING INFERIOR ALVEOLAR NERVE BLOCK - A PROSPECTIVE STUDY
Background and aims: It is a basic rule to aspirate before injection when giving an inferior alveolar nerve block because the local anaesthetic may fail if the injection is given into a blood vessel, and the local anaesthetic solution may have undesirable systemic effects. There are reports that indicate aspiration is not performed in every injection. The aim of the present study was to assess the incidence of intravascular needle entrance in inferior alveolar nerve block injections.
Patients and methods: Interns and postgraduates of our institute performed inferior alveolar nerve block injections using conventional technique in 250 patients undergoing minor oral surgical procedures. The results of aspiration were reported. Aspirable syringes and 27 gauge long needles were used, and the method of aspiration was similar in all cases.
Data were analyzed using t-test.
Results: 20% of inferior alveolar nerve block injections were aspiration positive. Of all injections, 15.8% were intravascular on the right side and 14.8% were intravascular on the left. There were no statistically significant differences between right and left injection sites (P = 0.778). Between the ages of 9 and 19 the incidence of intravascular penetration was significantly greater than at other ages (10/28 compared with 39/222, P = 0.04).
Conclusion: Aspiration of the syringe after the needle had been placed in position for an inferior alveolar nerve block (but before the anaesthetic solution was injected) in 250 patients showed that the tip of the needle was in a blood vessel in 49 (20%). Aspiration of blood was significantly more common in patients aged 9–19 years than in all others (P=0.04). It seems that side of injection has no considerable effect in incidence of intravascular needle entrance.
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- 1 Malamed SF. Handbook of Local Anesthesia. 3rd ed. St Louis: Mosby, 1990: 77.
- 2 Brand HS, Abraham-Inpijn L. Cardiovascular responses induced by dental treatment. Eur J Oral Sci 1996;104:245-52.
- 3 Bader JD, Bonito AJ, Shugars DA. Cardiovascular Effects of Epinephrine on Hypertensive Dental Patients. Evidence Report/ Technology Assessment Number 48. (Prepared by Research Triangle Institute under Contract No. 290-97-0011.) AHRQ Publication No. 02-E006. Rockville: Agency for Healthcare Research and Quality; 2002.
- 4 Pérusse R, Goulet JP, Turcotte JY. Contraindications to vasoconstrictors in dentistry: Part I. Cardiovascular diseases. Oral Surg Oral Med Oral Pathol 1992;74:679-86.
- 5 Blanton PL, Jeske AH. ADA Council on Scientific Affairs; ADA Division of Science. Avoiding complications in local anesthesia induction: anatomical considerations. J Am Dent Assoc 2003;134:888-93.
- 6 Lustig JP, Zusman SP. Immediate complications of local anesthetic administered to 1,007 consecutive patients. J Am Dent Assoc. 1999 Apr;130(4):496-9.
- 7 Bennett RC. Monheim's local anesthesia and pain control in dental practice. 7th ed. St. Louis, MO: C.V. Mosby Publishing; 1984.
- 8 Frangiskos F, Stavrou E, Merenditis N, Tsitsogianis H, Vardas E, Antonopoulou I. Incidence of penetration of a blood vessel during inferior alveolar nerve block. Br J Oral Maxillofac Surg. 2003 Jun;41(3):188-9.
- 9 Vasconcelos BC, Freitas K, Canuto M. Frequency of positive aspirations in anesthesia of the inferior alveolar nerve by the direct technique. Med Oral Patol Oral Cir Bucal. 2008 Jun1;13(6): E371-4.