Anesthesia in dentistry (pain relief)

Anesthesia plays a huge role in modern medicine. After all, thanks to it, doctors have the opportunity to perform operations and a number of special examinations that are accompanied by pain.

Modern anesthesia involves rather complex pain relief techniques. Therefore, for these purposes there is a certain doctor, who is called an anesthesiologist.

Spinal anesthesia

The largest percentage of pain relief occurs under general anesthesia, that is, anesthesia. However, it is also possible to perform local anesthesia. This type of loss of sensitivity involves anesthesia of only certain areas of the human body.

However, in certain situations and individual indications, another type of anesthesia is often performed, the name of which is “spinal anesthesia.”

What is spinal anesthesia?

This anesthesia technique represents a regional loss of sensation in the patient. In this case, there is a complete temporary “switching off” of any sensations in the area of ​​the body located below the navel. This type of anesthesia is an excellent replacement for general anesthesia. The process of injecting a patient with spinal anesthesia is carried out by injecting a certain drug into the back, which turns off the nerves responsible for pain.

During spinal anesthesia, the patient “turns off” sensitivity in the area below the navel

The advantages of this method of pain relief are:

• minimal blood loss during the operation;
• the risk of postoperative blood clots and pulmonary thromboembolism is significantly reduced;
• reducing negative effects on the lungs and heart;
• no nausea or weakness;
• absence of pain in the postoperative period;
• the possibility of direct contact with the doctor during surgery;
• the opportunity to eat well after surgery.

Anesthesia

Even the most knowledgeable patient is worried and asks a similar question: will it hurt me during and immediately after the operation, when the anesthesia wears off? The answer in this case may sound like this: thanks to the achievements of anesthesiology (a branch of medical science that studies various types of anesthesia and anesthesia), any, even the most complex and extensive operation will be painless, safe and comfortable for the patient.

ANESTHESIA is a condition in which, against the background of loss or preservation of consciousness, sensations are partially or completely lost, and therefore there is no pain. In the common sense, anesthesia refers to one or another method of relieving a patient of pain during surgical operations.

The purpose of anesthesia for surgical interventions is to adequately protect the body from surgical stress.

What types of pain relief exist in modern medicine?

Pain relief or anesthesia can be general or local.

Local anesthesia. It consists of introducing, using a syringe, into the area of ​​the operation being performed or into the area of ​​the peripheral nerves that control the pain sensitivity of the operation area, a special substance, a local anesthetic, which temporarily turns off the pain sensitivity. Local anesthesia can be infiltration (injection of anesthetic directly into the area of ​​incision and surgical manipulations), conduction (blockade of peripheral nerves and plexuses, epidural and subarachnoid anesthesia (at the level of the spinal cord) - injection of anesthetic into the area of ​​large nerves that provide pain sensitivity in the operation area, however, they themselves are outside this zone). During the operation, the patient is conscious under local anesthesia.

General anesthesia or anesthesia consists of temporarily turning off the central zones of pain sensitivity and the transmission of pain impulses in the brain or spinal cord.

Anesthesia can be intravenous or intubation.

During intravenous anesthesia, a drug is injected into the patient's vein, which causes the pain sensitivity centers of the brain to be turned off and at the same time turns off the patient's consciousness, maintaining, as a rule, spontaneous breathing.

Intubation anesthesia consists of a preliminary temporary shutdown at the level of the brain of the patient’s central pain sensitivity and consciousness, temporary paralysis of the muscles, followed by intubation (insertion of a breathing tube into the trachea) and artificial ventilation of the lungs (artificial respiration) using special breathing equipment for the entire duration of the operation. This type of anesthesia is used for major operations where it is required that the patient’s muscles are relaxed and involuntary or voluntary movements do not interfere with the surgeon and are completely excluded.

A special place among methods of general anesthesia is occupied by spinal (epidural) anesthesia, which consists of introducing local anesthetics of varying durations of action into the spinal canal, which leads to a temporary shutdown of pain and tactile sensitivity, as well as motor function below the injection site. Spinal anesthesia is usually supplemented with so-called intravenous sedation (medication sleep) and the patient sleeps during the operation.

Combined anesthesia is a broad concept that implies the sequential or simultaneous use of different types of anesthesia (inhalation anesthesia with local anesthesia), which allows for enhanced pain relief.

Recommendations for preparing for anesthesia

• Restrictions on food and drink intake. Do not eat or drink anything for a certain period of time before the anesthesia (average 8 hours).
• Restrictions on taking medications. If the patient takes any medications on a regular basis (for diabetes or heart disease), check with the anesthesiologist whether these drugs can be taken the day before and on the day of the procedure. Some drugs may interact with anesthetics and other drugs used for anesthesia.
• Using some mental relaxation techniques (focusing on optimistic and positive thoughts, relaxing and relieving tension by concentrating on a pleasant experience or a calming place, meditation).

Immediately before the operation, the patient is given premedication - complex drug preparation for anesthesia (they are given sleeping pills at night, narcotic analgesics 40 minutes before the operation).

Purposes of premedication: eliminate feelings of anxiety, fear and excitement; enhance the effectiveness of the upcoming anesthesia; prevent unwanted side effects of anesthesia.

What are the characteristics of the patient’s recovery from various types of anesthesia and the immediate postoperative period?

Very often, patients wonder what will happen to them and how they will feel when the anesthesia wears off? Of course, this depends on the type of anesthesia used, and on the type and extent of the operation, as well as on the general condition and individual characteristics of the patient’s pain sensitivity. After the local anesthesia wears off, patients usually experience slight pain in the area of ​​the surgical wound (the site of the surgical injury cannot help but hurt). Taking a pain reliever is usually enough to relieve these pains.

After intravenous and intubation anesthesia, patients feel as if they were after a good and deep sleep, sometimes they remember bizarre dreams, occasionally experience a headache, note nausea, and in isolated cases vomiting. After intubation anesthesia, there is a soreness and discomfort in the throat, which is associated with the presence of a breathing tube there during the operation. In the first hours after surgery, all patients are under close supervision of medical personnel of the anesthesiology service (anesthesiologist, nurse anesthetist). Only when the patient fully regains consciousness is he transferred to a regular ward.

REMEMBER THAT QUALIFIED ANESTHETIC CARE AND COMPLETE POSTOPERATIVE REHABILITATION ARE IMPORTANT COMPONENTS OF SURGICAL TREATMENT!

Technology of anesthesia

To ensure complete painlessness, anesthesia is administered into the cavity of the spinal column, located between the membranes of the brain and spinal cord. This area is filled with cerebrospinal fluid - cerebrospinal fluid. Thanks to the anesthetic entering this space, a complete “switching off” of the lower body is achieved. This result is achieved by blocking nerve impulses emanating from the nerve roots of the spine to the brain. Therefore, a person does not feel anything during the action of the drug.

An analgesic agent is injected into the subarachnoid space

Administering spinal anesthesia requires specialist technical skill as the process is not easy. In addition, spinal anesthesia is performed using medical instruments that reduce the risk of complications after anesthesia.

Such tools include:

• alcohol disinfecting cotton swabs for antiseptic procedures;
• two syringes, one of which contains a local anesthetic for a less sensitive spinal puncture. And the second syringe is filled directly with an analgesic agent for spinal anesthesia;
• a special needle for performing a spinal puncture. By the way, it is much thinner than the one used for epidural anesthesia.

Topical anesthesia in dentistry and drugs

Infiltration or application anesthesia in dentistry is carried out by soaking soft tissues with an anesthetic solution, as a result of which the nerve endings located in the treated area are blocked. With topical anesthesia, the anesthetic is applied without the use of a syringe. Using a cotton swab or your fingers, apply a small amount of the product, which subsequently penetrates approximately 3 mm inside and numbs the selected area. In dentistry, it is used to perform simple and quick operations associated with anesthesia of the oral mucosa, since it lasts, on average, from 10 to (in rare cases) 25 minutes. It is often preceded by subsequent injection anesthesia, especially if the patient is a child or is afraid of injections. There are also preparations for topical anesthesia in the form of aerosols. They are not widely used in dentistry due to difficulties in calculating dosage, as well as easy penetration into the respiratory tract and bloodstream, which increases the risk of complications.

The process of spinal anesthesia

After completing all the above doctor’s instructions, you can proceed directly to the anesthetic injection. To do this, the patient must provide the doctor with good access to the spine, taking a position lying on his side, or sitting, with his back bent as much as possible.

This is followed by treatment of the anesthesia injection area with antiseptic drugs and an injection of local anesthetic from the first syringe. Then the anesthesiologist administers the anesthetic, based on the rules for the technique of administering this anesthesia - specifically into the subarachnoid space.

The required dosage of the drug is calculated by the anesthesiologist in advance. It is determined based on an analysis of the individual characteristics of the human body: height, weight, age.

It is worth noting that the puncture site is usually located between the II and III vertebrae of the lumbar spinal column, but it is also acceptable to administer an anesthetic up to the V vertebra. The choice of location for spinal anesthesia depends on the individual structure of the spine, the presence of previous injuries or surgical interventions.

Spinal anesthesia is most often administered between the second and third or third and fourth lumbar vertebrae

Options for using infiltration anesthesia

The technique of local anesthesia has its own characteristics depending on the type of operation and area of ​​intervention. Currently, the classic version of infiltration anesthesia according to A.V. Vishnevsky is rarely used, but its elements continue to be used during various operations, including abdominal interventions.

One type of infiltration anesthesia is case blockade . It may be required for injuries or operations on the extremities. It is performed using a 0.25% solution of novocaine, trimecaine or lidocaine by introducing flexors or extensors into the sheaths. To do this, the skin and muscles are anesthetized, and then using a thin needle they reach the bone and, retreating a few millimeters, inject a certain amount of anesthetic. The drug is usually administered from two points. For closed fractures of the tubular bones of the extremities, the anesthetic can be injected directly into the hematoma.

Several types of infiltration anesthesia are used in dentistry: intramucosal, submucosal, spongy anesthesia, intrapulpal, intraligamentary, infiltration anesthesia of soft tissues, anesthesia under the periosteum.

Feel

After direct administration of the drug, a person gradually begins to feel heaviness in the legs or a slight tingling sensation. This indicates that the administered drug is beginning to work. After a few minutes, sensitivity completely disappears. Before surgery, the doctor must test for loss of sensitivity. If suddenly a person feels an unpleasant sensation, more like an electric shock, you should immediately tell a doctor about it.

In some situations, longer spinal anesthesia may be required. In this case, a special instrument, a catheter, is placed in place of the previous puncture for additional administration of the medicine.

Anesthetics for anesthesia

For spinal anesthesia, agents with various properties are used. Each of these drugs gives a different effect in terms of duration of exposure. Patients with allergic diseases should not worry: there are a lot of options for administered medications, and the doctor will definitely replace a drug that is unsuitable for the individual body with one with a similar effect. Here are some of the medications that are used for spinal anesthesia: Narolin, Novocaine, Mezaton, Fraxiparine, Lidocaine, Bupivacaine and many others.

"Mezaton"

For your information, the table below shows the active ingredients used in spinal anesthesia drugs, their dosages and the duration of action of each of them. Thanks to this table, the patient can determine whether he is allergic to a particular drug and whether the dosage is appropriate for him.

Technique of infiltration anesthesia

The method of infiltration anesthesia was developed at the end of the 19th century, but the anesthetics used at that time were highly toxic.
The technique became more widespread after the introduction of novocaine into practice. This agent could be administered in larger volumes without significant risk of toxicity. The disadvantages of infiltration anesthesia at that time were: delayed development of anesthesia, the need for additional tissue infiltration during surgery, and the risk of toxic effects of the anesthetic. A.V. managed to eliminate these shortcomings. Vishnevsky, who proposed the technique of tight “creeping infiltration”. The method is still widely used in small operations. Features of the technique include the use of a weak solution of novocaine (0.25%) and infiltration of a large volume of anesthetic into fascial closed spaces. The anesthetic solution is injected into the tissue under increased pressure and spreads over a considerable distance within the fascial sheath, while the drug acts on the axons of neurons innervating the intervention area. High hydrostatic pressure promotes closer contact of novocaine with nerve endings. This leads to a rapid development of anesthesia and allows the surgeon to immediately begin the operation. In addition, thanks to the “creeping infiltration” method, hydraulic tissue preparation is ensured, facilitating such surgical procedures as the separation of adhesions, tumor isolation, and others.

Advantages of the method

1. The rapid onset of the effect of loss of sensitivity and blocking of nerve impulses.
2. It is successfully used during caesarean section or to ease contractions during childbirth. Thanks to the safe effect on the patient’s body, the mother in labor does not have to worry about the health of the baby.
3. A much smaller dose of the drug enters the patient’s body compared to other types of anesthesia.
4. By using a thin needle when injecting the drug, the risk of internal damage is minimized.
5. This anesthesia technique involves the muscles being as relaxed as possible, which greatly helps the surgeon during the operation.
6. There is minimal intoxication of the body when the drug is administered, since the percentage of the anesthetic entering the blood is in isolated cases.
7. The analgesic effect does not affect the respiratory system; therefore, problems associated with the lungs are automatically excluded, as is the case with general anesthesia.
8. The patient remains conscious, which helps to immediately eliminate complications, since direct contact is maintained between doctors and the patient during the entire surgical process.
9. Minimal risk of complications after puncture due to the simplicity of the anesthetic injection technique.

Spinal anesthesia has many advantages

Negative consequences of spinal anesthesia

In order for the patient to decide to undergo spinal anesthesia, he needs to familiarize himself in advance with information about the disadvantages of this method of pain relief.

1. During the medication administration process, the patient's blood pressure may drop sharply. Therefore, hypotensive patients are given drugs that increase blood pressure in advance - of course, if necessary. For hypertensive patients, this consequence can only have a positive effect.
2. The time of loss of sensitivity is directly related to the dose of the drug. If sensitivity returns before the required time, and there is not enough time to complete the operation, the patient is immediately placed under general anesthesia. The spinal anesthesia method does not involve constant support of the anesthetic in the body; most often it is administered once. However, do not worry, since modern medicine uses medications that last up to six hours, which in most cases allows the surgeon to carry out all the manipulations on time.
3. Headaches are a frequent companion of the patient after recovery from anesthesia.

The essence of Vishnevsky's method is as follows:

1. The novocaine solution (fresh, of course) is heated to body temperature; 2. Fill it into a syringe (2 ml); 3. Liquid is injected under the skin.

As a result, a so-called lemon peel should form.

Gradually they move further and infiltrate other areas.

Vishnevsky included the following substances in his solution:

• sodium chloride (5 g);
• potassium chloride (0.075 g);
• calcium chloride (0.125 g);
• distilled water (1000 ml);
• and, in fact, novocaine (2.5 g).

For example, 50 ml of anesthetic is quite enough to anesthetize the upper jaw.

Indications for using spinal anesthesia technique

1. Surgery of the legs or perineum.
2. Reducing the risk of thrombosis in older people during leg surgery.
3. Due to the impossibility of administering general anesthesia for lung diseases, both acute and chronic stages.
4. Pinched sciatic nerve.
5. Radicular syndrome.
6. The need to reduce the tone of intestinal muscle tissue during operations on the gastrointestinal tract.
7. The need to relax the walls of blood vessels in people with heart problems, with the exception of hypertensive patients and patients with heart valve problems.

There are many indications for the use of spinal anesthesia.

Indications for general anesthesia

In some cases, patients are prescribed only general anesthesia. Such situations include large-scale surgical operations when the doctor is unable to complete them in a short period of time. In cases of dental treatment, general anesthesia is prescribed when the patient needs to have a large number of teeth removed or many implants installed.

Important! Along with this, this anesthesia is prescribed to people with allergies to local anesthetics, patients with a gag reflex during dental therapy, as well as those patients who will undergo surgery on organs above the navel.

Anesthesia technique

A solution of novocaine is injected intradermally with a thin needle, warmed to body temperature. As a result, a “lemon peel” is formed at the site of the upcoming cut. Then a thicker needle is used to infiltrate the subcutaneous tissue and create a subcutaneous novocaine infiltrate. After this, the skin and subcutaneous tissue are dissected to the aponeurosis. Following this, the subgaleal space is tightly filled with novocaine solution, ending with the opening of the aponeurosis. If the intervention requires it, subsequent anesthesia of the peritoneum, mesentery or pleura, and the root of the lung is performed. In all cases, when performing infiltration anesthesia, the surgeon adheres to the rule - infiltration with an anesthetic must precede an incision with a scalpel. Novocaine blockades proposed by A.V. are based on a similar principle. Vishnevsky. It also uses tight filling of anatomical “cases” with anesthetic, which does not require direct application of the drug to the nerve trunks.

Contraindications to the use of spinal anesthesia

Complete contraindications for spinal anesthesia are:

• direct refusal of the person to undergo the procedure;
• problems with blood clotting - to exclude volumetric blood loss;
• infection or inflammation at the site of future anesthesia injection;
• critical conditions of the patient in the form of shock, major blood loss, sepsis, pulmonary and cardiac dysfunction;
• allergy to all types of anesthetics used for puncture;
• meningitis and other infectious diseases of the nerves;
• hypertension;
• herpes;
• arrhythmia.

If there are absolute contraindications to spinal anesthesia, doctors will have to use a different method of pain relief

Relative contraindications, when the benefit significantly outweighs the harm caused to the patient by spinal anesthesia, include:

• changes in the structure of the spine, both congenital and acquired due to injury;
• the patient was given a pre-prognosis for heavy blood loss during surgery;
• fever associated with infectious diseases;
• multiple sclerosis, epilepsy and other diseases of the nervous system;
• mental disorders (when there is a possibility that the patient will not be able to lie still during surgery);
• use of aspirin shortly before the appointment of spinal anesthesia due to an increased risk of blood loss due to the properties of this drug;
• the likelihood of increased surgical time;
• childhood.

Types of infiltration anesthesia

Conventionally, two types of infiltration anesthesia can be distinguished: direct and indirect. With direct anesthesia, the drug is injected directly into the surgical area. This type of anesthesia is used during soft tissue operations.

With the indirect (diffuse) type of infiltration anesthesia, the anesthetic is administered at some distance from the area that needs to be anesthetized. By diffusion, the solution reaches the tissues in the intervention area. For example, introducing an anesthetic solution around the surgical field when opening an abscess or injection under the periosteum when numbing a tooth. The effect of the drug is determined not only by the pharmacokinetic properties, concentration and amount of solution, but also by the condition of the infiltrated tissues (local inflammation, scar-adhesive process reduce the analgesic effect).

Frequently asked questions from patients before agreeing to spinal anesthesia

How will I feel after the anesthesia is administered?

Answer. A couple of minutes after the injection of spinal anesthesia, heaviness in the lower extremities, slight numbness and warmth may be felt. After 15 minutes, the legs will be completely motionless.

How will I feel during the operation?

Answer. During a prolonged operation, a feeling of discomfort may occur due to the long static posture of the body. However, no pain will be felt. Also, discomfort during surgery can be caused by strong touches, stretching of the legs during the doctor's manipulations, or ambient noise. At the request of the patient, the anesthesiologist can put him into a state of light sleep for better comfort. At the same time, the specialist monitors his physical indicators: pulse, blood pressure, breathing and consciousness.

How will I feel after the surgery?

Possible side effects of spinal anesthesia

First of all, it should be noted that the number of side effects with this type of anesthesia is much less than after general anesthesia. Therefore, the risk of complications is reduced to a minimum and is extremely rare.

Possible complications are associated with pathologies present in the patient’s body, as well as age and bad habits.

We should not forget that all manipulations in anesthesiology, up to the installation of a regular IV, carry a certain risk. However, by strictly adhering to all doctor’s prescriptions, a person in most cases manages to avoid negative consequences.

Possible complications after anesthesia include:

• headache. This negative consequence most often appears due to the fact that after anesthesia a person begins to actively move. Statistics show 1% of the total number of complications. This pain syndrome goes away on its own within a couple of days. However, during this period it would not be amiss to measure blood pressure and act based on the tonometer readings. The main rule in this case is compliance with bed rest in the postoperative period;
• decrease in blood pressure. This negative factor is caused by the introduction of an anesthetic. As a rule, it does not last long. To normalize blood pressure, special intravenous solutions are administered and it is recommended to drink more fluids. This condition occurs in 1% of patients;
• pain in the anesthesia puncture area. The discomfort goes away within 24 hours and does not require additional treatment. If the patient cannot tolerate the pain, then you can take a Paracetamol or Diclofenac tablet;
• delay in the process of urination. A common occurrence that does not require therapy and usually resolves on the second day after surgery;
• neurological complications. An extremely rare phenomenon characterized by loss of sensation, muscle weakness and tingling in the lower part of the body lasting up to two days. If this problem persists for more than three days, you should consult a doctor.

There is always a certain risk of complications after spinal anesthesia, but fortunately it is extremely small

Preventing complications

In order to eliminate the risk of developing negative consequences, it is necessary to strictly follow the recommendations of the anesthesiologist.

1. 6-8 hours before surgery, do not eat or drink any liquids.
2. Do not smoke tobacco products 6 hours before surgery.
3. Do not wear makeup or polish your nails before surgery.
4. Remove contact lenses from your eyes and remove all removable dentures, if any, from your mouth. It is necessary to inform the anesthesiologist in advance about the presence of ocular prostheses if they are worn.
5. Remove rings from your fingers, earrings from your ears, chains from your neck, as well as other jewelry items. For believers, it is permissible to leave the cross on the body, but not on a chain, but on a braid.

Compliance with these recommendations significantly reduces the risk of complications.

The main thing is that the patient informs the anesthesiologist about all his diseases, previous injuries and surgical interventions, and also talks about the presence of possible allergies to medications or intolerance to any drugs. The specialist also needs to know whether the patient is taking medications. Collecting this information is the key to successful spinal anesthesia. This will also help prevent negative side effects after anesthesia.

Before administering anesthesia, the patient must inform the doctor about previous or existing diseases, taking any medications, injuries and other features

Before the operation, the patient should rest well and get enough sleep. It would be a good idea to spend some time in the fresh air and calm down. These simple steps will help you psychologically tune in to a positive wave, which will greatly facilitate the process of surgical intervention, and will also help the body recover faster after its completion.

Let's sum it up

Spinal anesthesia is an extremely safe method of pain relief. If the patient is faced with a choice between spinal and general anesthesia, then it is worth giving preference to the first - firstly, it does not require long preparation, and secondly, the recovery period after such anesthesia is short and, moreover, quite comfortable. There is no need to be afraid of this type of anesthesia - after a few hours, sensitivity is completely restored, and the patient can forget about any discomfort.