Complications Of Local Anesthesia Research Articles

Methemoglobinemia after Local Anesthesia with Prilocaine: A Case Report

Introduction: Methemoglobinemia due to local anesthesia is a rare phenomenon. Grey–blue cyanosis that is unresponsive to oxygen therapy after the administration of local prilocaine should be considered with methemoglobinemia due to local anesthesia, and methylene blue should be considered for treatment.Case Report: A 19-year-old man was admitted to Bakirkoy Dr. Sadi Konuk Training and Research Hospital emergency department with complaints of shortness of breath, bruising of the lips and nail, palpitations, and numbness in the extremities. Toenail shooting with local anesthesia was performed 3 h prior. On admission, he was restless. Cyanosis persisted on the limb and nails, and oxygen saturation was 78% by pulse oximetry under oxygen supplementation. We found the following results on physical examination: blood pressure, 115/77 mmHg; pulse, 123/min; and respiratory rate, 28/min. Arterial blood gas analysis revealed the following: methemoglobin level, 12.4%. Following the diagnosis of prilocaine-induced methemoglobinemia, he was treated using intravenous methylene blue, and his symptoms resolved.Conclusion: Methemoglobinemia, a rare clinical complication of local anesthesia, can be prevented by limiting the applied dose of local anesthesia. Treatment with methylene blue should be kept in mind along with supplemental oxygen therapy for patients with methemoglobinemia

Trends and complications of local anaesthesia in cataract surgery: an 8-year analysis of 12 992 patients

BackgroundCataract surgery has progressed from large incision to smaller incisions, which do not require sutures. Anaesthesia too has progressed from general anaesthesia to local anaesthesia to topical anaesthesia. The ideal...

Reduction of Complications of Local Anaesthesia in Dental Healthcare Setups by Application of the Six Sigma Methodology: A Statistical Quality Improvement Technique.

Health care faces challenges due to complications, inefficiencies and other concerns that threaten the safety of patients. The purpose of his study was to identify causes of complications encountered after administration of local anaesthesia for dental and oral surgical procedures and to reduce the incidence of complications by introduction of six sigma methodology. DMAIC (Define, Measure, Analyse, Improve and Control) process of Six Sigma was taken into consideration to reduce the incidence of complications encountered after administration of local anaesthesia injections for dental and oral surgical procedures using failure mode and effect analysis. Pareto analysis was taken into consideration to analyse the most recurring complications. Paired z-sample test using Minitab Statistical Inference and Fisher's exact test was used to statistically analyse the obtained data. The p-value <0.05 was considered as significant value. Total 54 systemic and 62 local complications occurred during three months of analyse and measure phase. Syncope, failure of anaesthesia, trismus, auto mordeduras and pain at injection site was found to be most recurring complications. Cumulative defective percentage was 7.99 in case of pre-improved data and decreased to 4.58 in the control phase. Estimate for difference was 0.0341228 and 95% lower bound for difference was 0.0193966. p-value was found to be highly significant with p= 0.000. The application of six sigma improvement methodology in healthcare tends to deliver consistently better results to the patients as well as hospitals and results in better patient compliance as well as satisfaction.

ABSTRACT 591

Background and aims: Methemoglobinemia is an uncommon cause of cyanosis. It is characterized by varying degrees of cyanosis due to increased hemoglobin concentrations containing oxidized iron. Acquired methemoglobinemia is caused by some drugs especially local anesthetics, some foods or water containing high levels of nitrate, and infections. Aims: Although prilocaine can cause severe methemoglobinemia in infants even in therapeutic doses, it is still widely used local anesthetic as a routine part of ambulatory circumcision procedures in Turkey. We aim to discuss this rare but potentially lethal complication of local anesthetics in infants and its treatment strategies. Methods: We report a case that presented with cyanosis and was diagnosed methemoglobinemia after receiving local anesthesia with prilocaine. Results: A 32 days old male was referred to our hospital with cyanosis which appeared 2 hours after circumcision. He had received local prilocaine during the procedure. In physical examination, no abnormality was detected except central cyanosis and restlessness. His past medical history was unremarkable. His oxygen saturation level was 88% despite of supplemental oxygen. In laboratory, blood methemoglobin level was 32%. He was treated with intravenous ascorbic acid. The methemoglobin level was decreased to 8.4% in 12th hour and 1.9% in 24th hour of the treatment. 72 hours after surgery, he was discharged from the hospital without any complication. Conclusions: Methemoglobinemia can be life-threatening. It should be included in differential diagnosis of infants presenting with acute cyanosis. Prilocaine should not be used in infants especially less than 3 months because of the risk of methemoglobinemia.

A Rare Complication of Local Anesthetics: Methemo-globinemia

A Rare Complication of Local Anesthetics: Methemo-globinemia

Peribulbar anesthesia in 750 patients treated with oral anticoagulants.

To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. A prospective case control study included 750 patients with oral anticoagulants in group A and 750 patients who had never been treated with oral anticoagulant in group B. Hemorrhages were graded as follows: 1) spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2) eyelid ecchymosis involving half of the lid surface area; 3) eyelid ecchymosis all around the eye, no increase in intraocular pressure; 4) retrobulbar hemorrhage with increased intraocular pressure. In group A, grade 1 was observed in 13 patients (1.74%) and grade 2 in 2 patients (0.26%). In group B, grade 1 was observed in 12 patients (1.6%) and grade 2 was absent. No 3 or 4 hemorrhage grade was encountered in both groups. There was not significant difference in grade 1 hemorrhage between both groups (P=0.21). Oral anticoagulants were not associated with a significant increase in potentially sight-threatening local anesthetic complications.

Peribulbar Block in Patients Scheduled for Eye Procedures and Treated With Clopidogrel

Our hypothesis was that the continuation of clopidogrel does not increase the risk of eye hemorrhage, compared to patients not treated with clopidogrel, when a peribulbar anesthesia is required. Our prospective case-control study enrolled two groups of 1,000 patients scheduled for intraocular eye surgery requiring a peribulbar block. Patients treated with clopidogrel were included in group A (1,000 patients). Patients who had never been treated with clopidogrel constituted the control group (group B, 1,000 patients). Hemorrhages were graded as follows: 1 = spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2 = eyelid ecchymosis involving half the lid surface area; 3 = eyelid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar hemorrhage with increased intraocular pressure. Grade 1 hemorrhages were observed in 30 patients (3.0 %) in group A and in 20 patients (2.0 %) in group B. No grade 2, 3, or 4 hemorrhage was encountered. There was no significant difference in the grading of hemorrhage between the groups (p = 0.017). Clopidogrel was not associated with a significant increase in potentially sight-threatening local anesthetic complications.

Peribulbar block in patients scheduled for eye procedures and treated with clopidogrel

Our hypothesis was that the continuation of clopidogrel does not increase the risk of eye hemorrhage, compared to patients not treated with clopidogrel, when a peribulbar anesthesia is required. Our prospective case-control study enrolled two groups of 1,000 patients scheduled for intraocular eye surgery requiring a peribulbar block. Patients treated with clopidogrel were included in group A (1,000 patients). Patients who had never been treated with clopidogrel constituted the control group (group B, 1,000 patients). Hemorrhages were graded as follows: 1 = spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2 = eyelid ecchymosis involving half the lid surface area; 3 = eyelid ecchymosis all around the eye, no increase in intraocular pressure; 4 = retrobulbar hemorrhage with increased intraocular pressure. Grade 1 hemorrhages were observed in 30 patients (3.0 %) in group A and in 20 patients (2.0 %) in group B. No grade 2, 3, or 4 hemorrhage was encountered. There was no significant difference in the grading of hemorrhage between the groups (p = 0.017). Clopidogrel was not associated with a significant increase in potentially sight-threatening local anesthetic complications.

Transient Binocular Diplopia as a Rare Complication of Local Anesthesia

Transient Binocular Diplopia as a Rare Complication of Local Anesthesia

Severe methemoglobinemia after dental anesthesia: a warning about propitocaine-induced methemoglobinemia in neonates

Methemoglobinemia is a fatal complication of local anesthesia. We describe a case report of female neonate who developed severe methemoglobinemia after extraction of neonatal teeth conducted with general anesthesia plus local injection of Citanest-Octapressin(®) (propitocaine of approximately 10mg/kg). Central cyanosis appeared within an hour after surgery. The percentage of methemoglobin reached up to 43.9%. Not only pediatric dentists but also anesthesiologists generally agree with the idea that local anesthesia provides various benefits in painful procedures in neonates. However, this case may serve as a warning when using Citanest-Octapressin(®), which is still commercially available for neonatal patients.

Methemoglobinemia presenting in a circumcised baby following application of prilocaine: a case report

IntroductionLocal anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics.Case presentationWe report the case of a 40-day-old Turkish boy who presented with cyanosis after receiving local anesthesia with prilocaine. His methemoglobin level revealed severe methemoglobinemia (methemoglobin = 44%). His cyanosis resolved after intravenous administration of methylene blue.ConclusionAlthough the association between prilocaine use and methemoglobinemia has generally restricted the use of prilocaine in babies, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in babies who are less than 3 months old because of the risk of methemoglobinemia; other local anesthetics may be used for this age group. Furthermore, general anesthesia by mask ventilation may be favored for babies less than 3 months of age instead of local anesthetics.

ADSA/NDBA Abstracts

ADSA/NDBA Abstracts

Complications of local anaesthesia. An observational study

Local anaesthesia is increasingly used by dental hygienists. As little is known about the incidence of adverse effects during and after the administration of local anaesthetics, we evaluated side-effects associated with local anaesthesia. A prospective observational study was conducted using standard criteria among a group of 103 patients receiving mandibular block anaesthesia. Physical reactions like clenching fists (14.5%), moaning (12.6%) and turning pale (7.8%) were frequently observed. Patients (3.8%) showed a painful reaction because of needle contact with a nerve or the periosteum. Systemic complications were not observed. After the injection, 41.7% said they felt tense during the administration; 4.9% of the patients reported swallowing problems and 3.9% a tachycardia. These results suggest that administration of local anaesthesia has a small risk of adverse events. Complications, if they occur, seem minor and transient in nature.

Methemoglobinemia due to application of prilocaine during circumcision and the effect of ascorbic acid

Local anesthesia with prilocaine has become a routine part of ambulatory circumcision procedures. Methemoglobinemia is a rare but potentially lethal complication of local anesthetics. We report the case of a 42-day-old boy who presented with cyanosis after receiving local anesthesia with prilocaine. Methemoglobin level revealed severe methemoglobinemia (methemoglobin = 44.5%). His cyanosis promptly resolved after intravenous administration of ascorbic acid. Cases of local anesthetic-induced methemoglobinemia in urology are under recognized. Although the association between prilocaine use and methemoglobinemia has generally restricted prilocaine use in infants, it is still widely used in ambulatory procedures, especially during circumcision in the neonatal period. Prilocaine should not be used in infants less than 3 months of age because of the risk of methemoglobinemia and alternative local analgesics should be considered among this age group. We also discuss the use of ascorbic acid during treatment in light of the literature.

Complications of Minor Skin Surgery Performed under Local Anesthesia

Minor surgical procedures performed under local anesthesia are the most common surgical procedures routinely carried out in every plastic surgical practice. The objective was to evaluate the prevalence of immediate local and systemic complications of such procedures. Records of 2,600 procedures performed under local anesthesia on 2,431 patients between November 2001 and May 2004 were reviewed. Local anesthetic complications and all surgical-related complications were recorded. Procedure-related complications were 51 presyncope (1.9%), 4 true syncope (0.16%), 2 minor burns (0.08%), and 1 facial laceration (0.04%). True allergic reaction to lidocaine is extremely rare and none was noted in our study. Most patients who claimed that they had suffered from such a reaction were probably experiencing symptoms related to intravenous injection administration, a reaction to the added vasoconstrictor (adrenaline), or a vasovagal reaction, which is a common trait among young adults.

Removal of broken dental needle using mobile digital C-arm

Breakage of needles is one of the most frustrating and distressing complications of local anesthesia. It is also one of the easiest to prevent. This article describes the use of the C-arm digital fluoroscope for retrival of a broken dental needle from the pterygomandibular space.

Rare Ocular and Cutaneous Complication of Inferior Alveolar Nerve Block

One of the most common procedures in dentistry/ oral and maxillofacial surgery is the administration of local anesthetics. Local anesthetics administrated carefully and within recommended dosage limits have established an enviable record of safety. Although life threatening systemic reactions do occur, most adverse effects or complications are local and temporary. Localized responses to anesthetic injections are fairly common. Immediate local complications of local anesthesia include hematoma formation, tissue blanching, facial paralysis, amaurosis, diplopia, needle breakage, positive blood aspiration, and burning sensation on impingement of the nerve. However, some side effects are less frequent, and rarely reported complications can be bizarre and difficult to explain. Some blanching of the mucous membrane is to be expected after submucosal administration of solutions containing vasoconstrictors. Infrequently, the skin over the injection site may also lose color. This effect is entirely harmless and disappears as the drug is absorbed into the systemic circulation. Momentary blanching of peripheral tissues supplied by an artery may be elicited by contraction of the blood vessel in reaction to needle impact or by mechanical stimulation of sympathetic vasoconstrictor fibers supplying the area. Also, even when clinicians use the utmost care, by aspirating before the injection and noting anatomic landmarks, intra-arterial injections can occur during regional nerve blocks. Unintended intravascular injections from inferior alveolar nerve blocks result in frustrating local complications. Ocular complications such as temporary blindness, ophthalmoplegia, diplopia, hysterical blindness, myosis, amaurosis, and ptosis were also reported after mandibular or Gow-gates block injection of local anesthesia. Although blanching, ischemia, and ocular complications are reported as rare local complications of local anesthesia, there are very few articles documenting patients and clinical photographs. Including the very recent ones, some textbooks do not even mention these complications. In this case report, 2 facial blanching and ocular symptoms immediately after local anesthesia administration are presented.

Methemoglobinemia: A Rare Complication of Local Anesthetics

Methemoglobinemia: A Rare Complication of Local Anesthetics

Inadvertent ocular perforation and intravitreal injection of an anesthetic agent during retrobulbar injection

We report the clinical management of a patient who sustained scleral perforation and intraocular injection of local anesthetic agent during retrobulbar block. We discuss the management options for this rare complication of local anesthesia in cataract surgery.

PERMANENT NERVE INVOLVEMENT RESULTING: FROM INFERIOR ALVEOLAR NERVE BLOCKS

This is a prospective study of patients referred to a tertiary care center with permanent alteration in sensation of the inferior alveolar nerves, lingual nerves or both that could have resulted only from an inferior alveolar nerve block. Working with a subject pool of 83 patients, the researchers outlined and photographed the area of altered sensation on each patient, tested it with von Frey's hairs and two-point discrimination and tested temperature sensation and direction sense. Among a study population of 55 women and 28 men with a mean age of 41.2 years, the lingual nerve was affected in 79 percent of patients and the inferior alveolar nerve in 21 percent of patients. In 47 patients, the causative inferior alveolar nerve block was painful when administered, but to the other 36 patients [corrected], it felt like a normal injection. Of the local anesthetic agents used, prilocaine was found to be more frequently linked to cases of nerve involvement in this study. Occasionally, an inferior alveolar nerve block can result in permanent involvement of the inferior alveolar nerve, lingual nerve or both. The incidence and exact mechanism of involvement still are unknown. By extrapolation from this study, an incidence of anywhere between 1:26,762 and 1:160,571 inferior alveolar nerve blocks can be surmised to result in this complication. A difference in referral rates for male and female patients is difficult to explain. The 34 percent [corrected] incidence of dysesthesia in the patients in this study is of concern. Permanent nerve involvement after receiving an inferior alveolar nerve block is a documented but very rare complication of the inferior alveolar nerve block, and the exact mechanism involved is still unknown. Permanent nerve damage can very occasionally occur as a result of an inferior alveolar nerve block. The exact mechanism is unknown, and there is no means of prevention. Knowledge of the risks and complications of local anesthesia is essential.