I found "Complications of an Intra-Arterial Injection From an Inferior Alveolar Nerve Block" by Dr. Brian Webber and colleagues (December JADA) interesting. It added another item with which I should concern myself during such an injection.
I have been practicing for 28 years now and have seen side effects of anesthetic injections including syncope, tachycardia, sleepiness, anxiety, paresthesia, hypoglycemia, etc. Now it seems that temporary blindness, diplopia and ptosis can be added to the list.
The article never addressed a very common problem many dentists engage in. In their haste to get the patients in and done, many have a habit of injecting much too fast. The anesthetic injection should take nearly two minutes (one minute per cubic centimeter) with very frequent aspiration—even if the needle is not moved.
This technique alone makes most anesthetic injections painless (and makes me wonder why anyone would purchase a computer-assisted anesthetic injection system).
I have had patients react to an injection reporting a shooting pain over a portion of the face not affected by the nerve involved. I have always assumed that it was a pressurized vein or artery. However, with the first reaction, I reposition the needle and have never had the reaction described in the article.
The article also makes reference to a second injection 30 seconds later—making me wonder if perhaps a rapid technique was used.
While I am sure that the facts about the consequences of an intra-arterial injection may well be true, I have a feeling that volume and speed of injection may well have contributed to the problem.
This was never addressed in the article.
