[Others]  Anesthesia Tips for larger surgeries



I am wondering what your protocol is for local anesthetic when performing All-on-4 procedures on the Maxilla.    Do you find that infilatration around the arch is usually sufficient, buccal and palatally?   I like the use of Articaine 1:100 to help control bleeding.  Do you routinely use a Maxillary Nerve Block or only if needed?  


I have never performed a Maxillary Nerve Block but my understanding is that the approach through the greater palatine foramen is the preferred route?   My research says the needle should be inserted roughly 30 mm followed by careful aspiration. What precautions need to be taken during this injection, do you have any tips/advice for administering this block?  What exactness is there to this 30 mm insertion depth, and what risks are associated with too shallow or too deep?


I had a difficult time anesthetizng the anterior edentulous maxilla in a grafted site last week, so I was hoping to get some advice for future cases....   prior to this case, infilatration seemd to be doing the job just fine.....


Also, is this block routinely used when doing a sinus lift procedure, or does infilrtation often do the trick?


Thanks again!



by Sean Bicknell at Thu, Feb 9, 2012 3:17 AM

2054 Views | 1 Replies


Likes : 0

Mark Kwon Replied at Thu, Feb 9, 2012 4:11 PM

Hi Sean, Good to hear from you always. Thanks for your post. Answer to your question would also apply to other dental procedures such as multiple extractions or sinus grafting etc... Most of the times, simple buccal and palatal infiltration works fine. However, if you are looking for something more profound and longer lasting, I would recommend blocks. Following are the typical blocks I may utilize: 1. PSA - posterior superior alveolar 2. V2 block - ie. into greaterpalatine foramen (you were referring to this) 3. Greater palatine block (anterior to foramen) 4. Incisive block plus , several areas along buccal with infiltration works well. - Infiltration of tissue with local anesthetic is unavoidable, since bleeding needs to be controlled with LA containing epinephrine (1:100,000 is fine , I would avoid 1:50,000) side effects of V2 block? hmm.. - Too shallow --> does not work -Too deep --> pt can go blind (temporarily) by freezing up optic nerve Hope this hleps.