Local Anesthesia Assignment

Dludla Bamangele
220004252
Local anaesthesia assignment: the advantages and
disadvantages of the addition of a vasoconstrictor in
dental anaesthetics…
Introduction
Local anaesthesia is one of the foundations of pain control used in
the dentistry department with some moderate deep sedation used
for invasive and painful procedures in contemporary oral and
maxilla-facial surgical model. It is one of fastest and most effective
method of relieving pain it can be either intraoperative or
postoperative pain. The knowledge of the pharmacology and
toxicology of these should assist in their intelligent and judicious use.
However, they are not completely effective on their own as they are
vasodilators in nature meaning they can dilate the blood vessels
increasing blood flow leading to bleeding and this is one of the
reasons why a vasoconstrictor is added to LA. The use of a vice
constrictor may set up a limiting factor over the number of cartridges
that can be administered safely over a period. the addition of a
vasoconstrictor in LA has many benefits just as it has many
disadvantages, one of the benefits is the prolongation of the
duration time and the quality of anaesthesia but studies do prove
that use of a vasoconstrictor is not always an optimal choice to take.
Advantages of addition of a vasoconstrictor in la
 The vasoconstrictor can decrease the peak plasma

concentration of the LA agent.
 a vasoconstrictor can lengthen the time in action of the LA
agents allowing it to remain around the nerve for a longer time
and shortens the onset time.
 it reduces the minimum concentration of LA needed for the
nerve block and reduces their systemic toxicity. The absorption
of the LA into the cardiovascular system is slowed leading to
lower anaesthetic levels.
 Reduces blood loss during surgical procedures this occurs as
the vasoconstrictor constricts the blood vessels reducing the
blood flow thus prevents a lot of bleeding at the site of
administration. The vasoconstrictors are drugs that constrict
the blood vessels therefore they control tissue perfusion, they
are there to oppose the vasodilatory actions of the local
anaesthetics.
 Vasoconstrictor enhances the haemostatic effect of LA agents
and the intensity.
Disadvantages of the addition of a vasoconstrictor in la.

As much as there benefits of adding a vasoconstrictor it also has
some detrimental effects it has on a human’s body especially of
those medically compromised patients, these patients include those
with hypertension, heart disease, hypokalaemia and other medical
conditions. The vasoconstrictors may interact with the type of
medication a patient is taking or receiving.
 If adding excessive vasoconstrictor in LA intravascularly by

injection it is absorbed into the vascular system as the
anaesthetic and if the gingival retraction cord is overused
particularly in patients with cardiovascular disease it can cause
vasoconstriction toxicity. This increased vasoconstriction can
cause a moderate increase in both systolic and diastolic blood
pressure, cardiac output and stroke volume which can lead to a
decrease in the overall cardiac efficiency, numerous studies
have been able to prove this statement. Angina or a heart
attack (myocardial infarction) can result if the patient’s
cardiovascular system cannot respond to the demand caused
by the vasoconstrictor. Studies have shown that small amounts
of vasoconstrictor can raise resting plasma catecholamine
concentrations.
 Local anaesthesia with vasoconstrictors has been associated
with ischemic conditions of the pulp and the alveolar bone and
be linked to increased incidences of osteitis after tooth
extraction.
 The presence of the vasoconstrictors is also associated with
local tissue damage at the site of injection.
 Other potential risks with vasoconstrictor in procedures are the
rebound or delayed postoperative bleeding and impaired
wound healing.
 They may add up to toxicity by also decreasing anesthetic
uptake or directly influencing the neural elements, the
symptoms of vasoconstrictor toxicity are identified as
headache, cardiac arrest, restlessness etc.
 It has been studying that epinephrine which is one of the main
vasoconstrictors used heightens sensory impairment which is
induced by intrathecal lidocaine.
References
http://www.scielo.org.za/pdf/sadj/v72n4/09.pdf
Vasoconstrictors in local anesthesia for dentistry. (nih.gov) Vasoconstrictors in local anesthesia for
dentistry. (nih.gov)
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce391/anesthetic-reaction-to-
vasoconstrictor
https://www.sciencedirect.com/topics/neuroscience/vasoconstrictors
https://www.youtube.com/watch?v=PfYFXwmXje0
https://www.researchgate.net/publication/16607495_local_Anesthesia_in_dental_practise
https://pubmed.ncbi.nlm.nih.gov/8250339
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce391/anesthetic-reaction-to-
vasoconstrictors

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Dludla Bamangele

 The vasoconstrictor can decrease the peak plasma

Disadvantages of the addition of a vasoconstrictor in la.

 If adding excessive vasoconstrictor in LA intravascularly by

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