What Is Perianesthesia?

Infiltration anesthesia is a method of injecting local anesthetics into the surgical site, subcutaneously, mucosa and deep tissues to anesthetize sensory nerve endings or neural stems to make them lose the ability to sense and conduct stimulation.

Chinese name: Infiltration anesthesia
Inject: Surgical site, subcutaneous, mucosal

Meaning: Anesthetize sensory nerve endings or nerve trunks
Anesthetic: Lidocaine, Bupivacaine

Introduction to Infiltration Anesthesia

Infiltration anesthesia is a method of injecting local anesthetic solution into tissues to act on nerve endings and cause them to lose the ability to conduct pain sensations to produce anesthetic effects.

Soft tissue infiltration anesthesia

For oral and maxillofacial soft tissue surgery, 0.25% -0.5% procaine or 0.25% ~ 0.5% lidocaine is commonly used for infiltration anesthesia.

The method of soft tissue infiltration anesthesia is to first inject a small amount of anesthetic into the skin or mucous membrane to form a small skin mound, and then along the surgical incision line, from shallow to deep, layered injection into the tissue of the surgical area, local anesthetic drugs diffuse, penetrate, and occur well The anesthesia effect of the anesthesia, meanwhile, by the tension generated in the tissue during the injection, the amount of capillary bleeding in the operation area is significantly reduced, the surgical field is clear, and the tissue is easy to separate.

Supraperiosteal and submucosal infiltration anesthesia

In dental and alveolar surgery, infiltration anesthesia is usually applied to the alveolar process of the maxillary alveolar process or the anterior mandibular area of the mandible, because the alveolar bone in these parts is relatively thin and porous, and the local anesthetic solution is easy. It penetrates into many small holes, enters the jawbone, and anesthetizes the dental plexus. Common infiltration anesthesia methods are:

Periosteum infiltration: Anesthetic is injected outside the periosteum of the apex of the tooth;

Submucosal infiltration: Anesthetic is injected into the submucosal tissue, and does not require to reach the subperiosteal.

Common methods of infiltration anesthesia

Soft tissue infiltration anesthesia

1. Indications: Large-scale surgery of the oral and maxillofacial region.

2. Method: Inject a small amount of local anesthesia into the skin and mucosa to form a small skin mound, and then follow the surgical incision line, from shallow to deep, layered injection into the tissue of the surgical area. A good anesthetic effect occurred. At the same time it can play a role in hemostasis and easy sharing of tissues.

Periosteal infiltration

1. Indications: Surgery of maxillary and mandibular anterior teeth and alveolar embarrassment.

2. Method: Inject the needle in the vestibular sulcus of the cheek and buccal side of the tooth to be anesthetized. After the needle tip angle reaches the bone surface, the needle should be retracted about 0.2cm, and then 0.5-2ml of anesthetic is injected.

Periodontal ligament injection

1. Indications: It is suitable for hemophilia and similar patients with a tendency to hemorrhage. When the analgesic effect of infiltration anesthesia or block anesthesia is incomplete, the addition of periodontal wax injection can often achieve better analgesic effects.

2. Method: Use a short and thin injection needle to pierce the periodontal membrane from the mesial or distal side of the tooth to a depth of about 0.5 cm and inject 0.2 ml of local anesthetic respectively. ^[1]

Common drugs for infiltration anesthesia

Commonly used local anesthetics are procaine, lidocaine, bupivacaine, and ropivacaine.

Precautions for infiltration anesthesia

The medicinal solution injected into the tissue needs a certain volume, which creates tension in the tissue, and makes the medicinal solution widely contact with nerve endings by the action of water pressure, thereby enhancing the anesthetic effect.

In order to avoid the dosage exceeding one time limit, the concentration of the drug solution should be reduced, for example, 0.25% procaine.

Withdraw before each injection to avoid accidental injection into the blood vessels.

There is no pain in parenchymal organs and brain tissues.

The adrenaline concentration in the medicinal solution is 1: 200,000-400,000 (that is, 2.5-5 g / ml), which can slow the absorption of local anesthetics and prolong the action time.

One point is that epinephrine is rarely added to the anesthetic solution for infiltration anesthesia to prevent local tissue necrosis caused by excessive contraction of surrounding blood vessels. Epinephrine can generally be added to common medicinal solutions such as epidural anesthesia and brachial plexus block anesthesia at the same concentration as above.

Difference between infiltration anesthesia and superficial anesthesia

A local penetrating drug with strong penetrating power is applied to the surface of the mucosa to make it penetrate the mucosa and block the nerve endings located under the mucosa. This method is commonly used for superficial surgery or endoscopy of the eyes, nose, throat, trachea, urethra, etc. Ophthalmic drip method, nasal application method, throat trachea spray method, and urethral infusion method. Commonly used drugs are 1% -2% tetracaine or 2% -4% lidocaine. Because the eye binding membrane and corneal tissue are soft, 0.5% -1% tetracaine is needed for eye drops. The trachea and urethral mucosa are absorbed faster and the dose should be reduced.