Journal of Current Medical Research and Opinion

Received 18-06-2020 | Accepted 23-07-2020 | Published Online 24-07-2020

DOI: https://doi.org/10.15520/jcmro.v3i07.317
CMRO 03 (07), 537−548 (2020)
ISSN (O) 2589-8779 | (P) 2589-8760

REVIEW ARTICLE

Local Anesthesia - Solution to Pain : An Overview

∗
Asima Jaan1 Rudhra Munshi2 Kriti Sareen3 Ekta Parmar4 Purnima Thakur5
Anannya Anindita6
1
MDS, Paedodontics and Abstract
Preventive Dentistry, Jammu, Local anesthetics have been used clinically for more than a century, but
Jammu and Kashmir
new insights into their mechanisms of action and their interaction with
2
PG Student, Department of biological systems continue to surprise researchers and clinicians alike.
Orthodontics and Dentofacial
Local anesthetics must traverse several tissue barriers to reach their
Orthopaedics, Genesis Institute of
Dental Sciences and Research, site of action on neuronal membranes. In particular, the perineurium
Ferozepur, Punjab is a major rate-limiting step. Previously it was assumed that patients
3
MDS, Oral Medicine and are rarely allergic to local anesthetic agents, but variation in individual
Radiology, New Delhi patient’s response to local anesthetics is larger than previously assumed
4
MDS, Oral Medicine and
adjuncts available to block sensory nerver are there, but these typically
Radiology, Godhra, Gujarat also prolong motor block.
5 Keywords: Anesthesia, Complication, Lignocaine, Toxicity
PG Student, Department of
Orthodontics and Dentofacial
Orthopaedics, Himachal Institute
of Dental Sciences, Paonta Sahib,
Himachal Pradesh
6
Dental Surgeon, Bhubaneswar,
Odisha

1 INTRODUCTION: administered by dentist to relieve pain.These drugs

D
when applied in sufficient concentration at the site
espite being in clinical use for more than a of action prevent conduction of electric impulses
century, local anesthetics (LA) continue to by membrane of nerves and muscle. (3) The aim
surprise researchers and clinicians alike. (1)
Various routes by which these drugs can be used Supplementary information The online version of
are infiltration, nerve block, for neuraxial anesthesia this article (https://doi.org/10.15520/jcmro.v3i07.31
and intravenously. Their clinical introduction 7) contains supplementary material, which is avail-
profoundly changed perioperative medicine. Today, able to authorized users.
in parallel with advances in neurosciences, our Corresponding Author: Asima Jaan
understanding of LA has become much more MDS, Paedodontics and Preventive Dentistry, Jammu,
detailed. (2) Local anesthetic agents are the most Jammu and Kashmir
commonly used drugs

CMRO 03 (07), 537−548 CURRENT MEDICAL RESEARCH AND OPINION 537

LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

of this review is to highlight key aspects of LA (3) Quinolone: Centbucridine.

pharmacology and toxicology and delineate current Based on potency and duration
research.
Injectable:
A) Low potency, short duration: Procaine, Chlorop-
Definition rocaine
It is defined as a loss of sensation in a circum- B) Intermediate potency & duration: Lidocaine,
scribed area of the body caused by depression of Prilocaine.
excitation in nerve endings or an inhibition of the
conduction process in peripheral nerves(Stanley F C) High potency & long duration: Bupivacaine,
Malamed,1980). (4) Tetracaine.
Surface anesthetic:
History (5, 6) Soluble: Cocaine, Tetracaine. Benoxinate, Ligno-
caine.
The 1st chemical local anesthetic came with dis-
covery of cocaine in 1860 by Albert Nieman, Insoluble: Benzocaine, Oxethazine
but its anesthetic property was not realized un- Theories of regional anaesthesia (4, 8)
til in 1862 when Schraff noted its local effect on
tongue. William Halsted Steward carried out the 1st 1. Electrical potential theory
recorded inferior dental nerve block using cocaine in
1884.Modern chemical LA agents came of age when 2. Acetycholine theory
Alfren Einhorn achieved esterification of the base
alcohol with benzoic acid to synthesize procaine in 3. Interference with nerve metabolism
1904-1905. Lofgren succeeded in synthesizing Li-
4. Reversible coagulation theory
docaine from a series of aniline derivatives in 1943.
Bupivacaine became the longest acting amide LA in 5. Plasma membrane expansion theory
1980’s to be followed by Rupivacaine in mid 1990.
On the basis of myelinated and non myelinated, di- 6. Calcium gate theory
ameter and velocity, nerve fibres have been
7. Specific receptor theory (most accepted): Ac-
classified into different categories Table 1 (7)
cording to this theory the LA agent acts by
Classification of LA (4) binding to specific receptors that are present on
Based on structure the sodium channel. The action of the drug has
(1) Esters: They possess an ester linkage between been stated to be direct & involves the binding
the benzene ring and the intermediate chain. of the agent to the specific receptor & prevents
the entry of sodium into the cell.
• Esters of Benzoic acid (ESTER GROUP) It in-
cludes Butacaine , Cocaine, Ethyl Amino Ben-
zoate, Benzocaine, Piperocaine, Tetracaine Pharmacokinetics (4, 9)
• Esters of paraamino benzoic acid: Chloropro- Uptake: All LA produce vasodilatation of vascular
caine, Procaine, Propoxycaine. bed into which they are deposited except cocaine
which is a potent vasoconstrictor.A significant effect
(2) Amide: They possess an amide linkage be- of it is vasodilatation, increased absorption of LA
tween the benzene ring & intermediate chain. Various into blood leading to decreased duration and
amide available are Articaine, Bupivacaine, Dibu- potential for toxicity.The rate at which LA is
caine, Etiodacaine, Lidocaine, Mepivacaine & Prilo- absorbed into the blood and reach their peak level
caine. vary acc. to the route of administration.

CMRO 03 (07), 537−548 (2020) CURRENT MEDICAL RESEARCH AND OPINION 538
 Jaan A et al.
CURRENT MEDICAL RESEARCH AND OPINION
TABLE 1: Classifica on of nerve fibres

Distribution: Distributed to all tissues especially • Minimal systemic toxicity.

to highly perfused organs(brain, liver, kidney).But
skeletal muscle (not among the highly perfused or- • Anesthesia is selective to nociception pathway
gan) which form the largest mass of tissue in body
contains the greatest percentage of LA. Composition of LA (8)
1) Local anesthetic agent: Conduction blockade
Metabolism 2) Vasoconstrictor: Decrease absorption of local
Ester LA : Hydrolysed in plasma by psuedo- anesthetic into blood, thus increasing duration of
cholinestrase.Faster the hydrolysis , lesser is toxic anesthesia & decreasing toxicity of anesthetic.
potential. Chloroprocaine (least toxic) &Tetracaine 3) Sodium Metabisulfite: Antioxidant for vasocon-
(most toxic). Allergic reactions in response to ester strictor.
drugs are due to PABA (major metabolite of ester 4) Methyl paraben: preservative to increase shelf
LA). life, Bacteriostatic
Amide LA : Liver is the primary site.Patient with 5) Sodium chloride: Isotonicity to solution.
lower than usual hepatic blood flow (hypotension,
6) Sterile water: diluents
CHF, cirrhosis) are unable to biotransform amide LA
at a normal rate leading to increase chance to toxicity. Indications (11, 12)
These conditions represent a relative contraindica-
tion to amide LA. • Extraction of teeth.
Excretion: Mainly excreted by kidney.% of a
• Alveoloplasty and alveolectomy.
given dose of LA will be excreted unchanged in
urine.Esters appear in small concentration.Amides • Incision and drainage of abcesses.
are present in urine as parent compound .
Characterstics of an ideal local anaesthetic (10) • Cavity preparation especially in deep painful
cavities.
• Adminstration of agent is non irritating
• Pulp procedures like pulpotomy and pulpec-
• Little or no allergenicity tomy.

• A rapid onset & adequate duration • Periodontal surgery and gingival surgery.

• Completely reversible. • Cyst enucleation or marsupialization

CURRENT MEDICAL RESEARCH AND OPINION CMRO 03 (07), 537−548 (2020) 539
LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

Mechanism of action

• Removal of residual infection, small neoplastic Contraindications (11, 12)

growths and salivary stones etc.
• Fearful and apprehensive patients who refuse
• Sore spots as a result of denture get relieved
for injection.
• Treatment of trismus and trigeminal neuralgia • Allergy to local anaesthetic solution.
• In patients who shows gagging especially dur- • Acute infection.
ing placement of film.
• Mentally retarded and unco-operative children
• For anesthesia of oral cavity and jaw bones or very young children.
for routine surgical procedures like treatment of
fractures etc. • Anatomic anomalies.

CMRO 03 (07), 537−548 (2020) CURRENT MEDICAL RESEARCH AND OPINION 540
 Jaan A et al.
CURRENT MEDICAL RESEARCH AND OPINION
• Hyperthyroidism, Liver disorders, Renal disor- altered, the condition is called methemoglobinemia.
ders, Cardiac problems, Diabetes mellitus. Typical symptoms include cyanosis, dyspnea,
emesis & headache. To reduce the risk clinician
• Internal hemorrhage. should take care to refrain from giving excessive
• Major oral surgical procedure dosages of local anesthetics.
Peripheral Nerve Paresthesia: Articaine is associated
Adverse effect of local anesthesia (13–18) with fivefold higher incidence of paresthesia com-
pared with lidocaine. as it can cause damage to
inferior nerve or lingual nerve.
1. Caused by anesthetic solution. Allergic Reaction: The amide local anesthetics ap-
pear to have an extremely little immunogenic and
2. Caused by vasoconstrictor drugs therefore low rate of allergic reactions.
Reaction to Anesthetic Formulations contaning a
3. Local reactions Sulfite Antioxidant: Allergic reactions like urticaria,
bronchospasm & anaphylaxis. The use of local anes-
4. Complications attributed to needle insertion thetic without vasoconstrictors is a possible alterna-
tive with these patients.
2. Caused by Vasoconstrictor Drug
1. Caused by Anesthetic Solution For prolong action of local anesthetic solution and to
reduce its toxicity, vasoconstrictors have been added
Sign and symptoms but its addition lead to contraindication of local anes-
thetic solution in various patients like in cardiac pa-
Central Nervous System: All LA produces a se- tients especially those suffering from refractory dys-
quence of stimulation followed by depression. Lido- rhythmias, angina pectoris, postmyocardial infarc-
caine toxicity may commence at concentrations >5 tion (6months) and uncontrolled hypertension. Other
µg/mL, but convulsive seizures generally require contraindications to vasoconstrictors are endocrine
concentrations >8 µg/mL. disorders such as hyperthyroidism, hyperfunction
of the medullary adrenal (pheochromocytoma) and
uncontrolled diabetes mellitus.
Cardiovascular Reactions: These are cardiac depres-
sants but no significant effects are seen at conven-
tional doses. Bupivacaine is relatively more car- Symptoms: Palpitation, Tachycardia, Headache,
diotoxic & can produce ventricular tachycardia. Li- Apprehension
docaine has little effect on contractility & conduc- Treatment: Brief duration reaction, so stop drug
tivity & is used as an antiarrythmic agent. administration and reassure the patient.
Blood vessels: Cause fall in blood pressure. This 3. Caused by local reactions
is primarily due to sympathetic blockade, but high
Infections caused by contaminated solutions are rare
doses do cause direct relaxation of arteriolar smooth
because of high standard of asepsis practiced by
muscles.
manufacturers.
Methemoglobinemia: A metabolite of prilocaine, o-
toluidine, can oxidize the iron in hemoglobin from
ferrous (Fe2+ ) to ferric (Fe3+ ). Altered Heme do Prevention: Use LA cartridges only once. Store
not bind oxygen and normal hemes on the same cartridges as aseptically as possible. Before inserting
hemoglobin molecule do not readily release their needle into the cartridge, rubber diaphragm should be
oxygen. This form of hemoglobin is called methe- wiped with sterile disposable alcohol sponge.
moglobin and when >1% of total hemoglobin is so 4. Caused by Needle Insertion

CURRENT MEDICAL RESEARCH AND OPINION CMRO 03 (07), 537−548 (2020) 541
LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

(A) Syncope: Most frequent complication. It is a embedded in tissue, Do not use needle of too fine
form of neurogenic shock caused by cerebral is- a gauge, Do not use resterilized needle & Inform the
chemia secondary to vasodilatation. patient before inserting the needle
Sign and Symptoms (E) Hematoma
Pallor, Nausea, Vomiting, Patient may feel strange It is associated with posterior superior alveolar nerve
or different, Unconsciousness, Bradycardia and Hy- block and infraorbital nerve block. Occurs because of
potension improper technique.
Treatment : Treatment
Immediate: Direct pressure to the bleeding site for
• Stop the dental procedure. at least 2 minutes.
• Lower the chair back and elevate the legs of the Subsequent: Do not apply heat to the area for 6 to
patient. 8 hours after the incident. Application of ice to the
region immediately and reassure the patient.
• If patient is conscious, instruct him to take deep Techniques of Local Anesthesia
breath.
1. Topical Anesthesia (4, 19, 20) : For obtaning the
• Check patients BP, pulse rate and color. anesthesia of mucosa prior to injection, a suitable
agent is applied to an area of either the skin or
• Ensure adequate oxygenation and CVS stabil- mucous membrane which it penetrates to anesthetize
ity. superficial nerve endings.
(B) Muscle Trismus (a) Sprays: Sprays are useful because of their rapidity
of action.The active ingredient is 10% lignocaine
Common and mainly occurs after inferior alveolar
hydrochloride in a water miscible base, which is ex-
nerve block.
pelled in small quantities from an aerosol container.
Causes: Trauma to muscle during insertion, Infection The onset time of anesthesia is approximately 1 min
(local), Hemorrhage. & the duration about 10 min.
Treatment (b) Ointments & Jelly: Ointments containing 5%
Mild: Slight exercises coupled with application of lignocaine hydrochloride can be used for a similar
moist warm compresses for 15-20 min. /h, Mild purpose, but it takes 3-4 min to produce surface
analgesics, Physiotherapy consist of opening closing anesthesia. It is occasionally used to produce surface
and side to side movement for 5-10 min. after every anesthesia prior to incision of fluctuant abscesses.
3-4 hrs. (c) EMLA (Eutectic Mixture of Local Anesthetics
Severe: Add centrally acting muscle relaxant ) : EMLA cream (composed of lidocaine 2.5% &
prilocaine 2.5%) is an emulsion in which the oil
(C) Pain or Hyperesthesia
phase is a eutectic mixture of lidocaine & prilocaine
Most commonly occur due to carelessness of dentist. in 1:1. Usually anesthetic solutions work on abraded
Prevention: Use Sharp needle, No multiple traumas, skin but it provides anesthesia to intact skin
Needle insertion should be Atraumatic and slow, LA Indication: In pediatrics, Vein puncture, Suture re-
should be forced into the tissue slowly. moval, Split thickness skin graft , Pulpal anesthesia
and Needle phobic patients
(D) Broken Needle
Contraindications : Patients with congenital/ idio-
Most annoying and depressing complication of anes- pathic methemoglobinemia, Infants under the age of
thesia. 12 months and Patients allergic to local anesthesia
Prevention : Do not force needle against resistance, 2. Local Infiltration: In this, local nerve endings in
Do not change the direction of the needle while the area of surgery are flooded with local anesthetic

CMRO 03 (07), 537−548 (2020) CURRENT MEDICAL RESEARCH AND OPINION 542
 Jaan A et al.
CURRENT MEDICAL RESEARCH AND OPINION
solution, rendering them insensitive to pain or pre- thetized: Posterior portion of hard palate & its over-
venting them from becoming stimulated & creating lying soft tissues anteriorly till 1st premolar.
an impulse. Incision is then made into the same area 10. Infraorbital Nerve Block
in which the local anesthetic has been deposited. (4)
Nerves anesthetized : Anterior superior alveolar
3. Field Block: Solution is deposited near the larger nerve, Middle superior alveolar nerve, Infraorbital
terminal nerve branches so the anesthetized area will nerve , Inferior palpebral branch, Lateral nasal
be circumscribed. An incision is made away from the branch Supeior labial branch
site of injection. (4)
Regions anesthetized: Maxillary central incisors
4. Nerve Block: Local anesthetic is deposited close to upto maxillary premolars, MB root of 1st molar &
main nerve trunk, usually at a distance from the site buccal investing tissues.
of operative intervention. (4)
11. Nasopalatine Nerve Block
5. Intrapulpal: It is utilized in cases of pulp therapy
Nerves anesthetized: Nasopalatine nerves bilaterally.
where the other techniques have failed. The needle
is bent for the purpose of proper positioning . Also Regions anesthetized: Anterior portion of hard palate
a sufficient amount of pulp tissue needs to be from 1st premolar to 1st premolar.
engaged for the solution to be injected into it. (21) 12. Maxillary Nerve Block
6. Intraosseous: When the anesthetic is injected in Nerves Anesthetized: Maxillary nerve & its
the bone through a hole in the cortical plate, the tissue branches.
will not affect it & it anesthetizes only the area of Area anesthetized: Maxillary teeth, overlying bone
treatment, not the quadrant. (21) & mucosa on the affected side, Hard & soft palate ,
Maxillary Anesthesia (4, 21–23) Upper lip, cheeks, side of the nose & lower eyelid.
1. Posterior Superior Alveolar Block: For several Supplemental Anesthesia Techniques
molar teeth in one quadrant.
1. Supraperiostal (Infiltration): recommended for
2. Middle Superior Alveolar Block: For management limited treatment protocols
of premolars in one quadrant.
2. Periodontal Ligament Injection : recommended as
3. Anterior Superior Alveolar Block: For manage- an adjunct to other techniques or for limited treat-
ment of anterior teeth in one quadrant. ment protocols
4. Maxillary Nerve Block: For extensive buccal, 3. Intraseptal Injection: For periodontal surgical
palatal & pulpal management in one quadrant. techniques.
5. Greater Palatine Nerve Block: For palatal & soft 4. Intraosseous: for single tooth when other tech-
osseous tissue treatment distal to canine in one quad- niques have failed.
rant.
Mandibular Anesthesia (4, 19, 22, 24, 25)
6. Nasopalatine Nerve Block: For palatal & osseous
1. Mental & Incisive Nerve Block
tissue management from canine to canine bilaterally.
Nerves anesthetized: Mental & incisive nerves.
7. Supraperiostal Injection: For obtaining pulpal
anesthesia in maxillary anterior teeth when treatment Regions anesthetized: Lower lip, Mucosa anterior to
is limited to one or two teeth. mental foramen, teeth anterior to second premolar.
8. Posterior Superior Alveolar Nerve Block : Nerve 2. Classical Inferior Alveolar Nerve Block
anesthetized: Posterior superior alveolar nerve. Re- Nerves anesthetized: Inferior alveolar, incisive, men-
gions anesthetized: 1st, 2nd, 3rd maxillary molars & tal & lingual nerve.
their investing tissue except palatal mucosa. Regions anesthetized: Mandibular teeth & buccal
9. Greater or Anterior Palatine Nerve Block :Nerves soft tissues anterior to 1st molar & anterior 2/3rd of
anesthetized: Greater palatine nerve. Region anes- tongue & floor of the mouth.

CURRENT MEDICAL RESEARCH AND OPINION CMRO 03 (07), 537−548 (2020) 543
LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

3. Closed Mouth Approach (Vazirani-Akinosi • Presence of allergy, patient’s size and age, emo-
Block) tional or psychological problems.
Nerves anesthetized: Inferior alveolar, incisive,
• Medications the patient may be taking
mental, lingual & mylohyoid nerves.
4. Gow-Gates Nerve Block: It is an intraoral CVS status: Conditions concerned to dentists are
mandibular nerve block given at neck of condyle & Congenital heart disease, Acquired heart disease,
provides hard & soft tissue anesthesia of mandible Rheumatic heart disease, Atherosclerotic heart dis-
upto the midline. Mandibular nerve & its branches ease, Hypertension, CHF, Valvular heart disease Ar-
are blocked including its auriculotemporal subdivi- rhythmia(conduction system defect).
sion.
Precautions
Preanesthetic evaluation (26)
Preanesthetic evaluation should be done before ad- • Consultation with patient physician taken when
ministering any anesthetic drug. It is done to secure indicated.
pertinent information to evaluate and not to diagnose
or treat the patient for any medical problem. It is done • Procedure should be planned to fit the individ-
to determine the following: ual patient condition.

• If patient is anxious, he should be moderately

• Patients general and psychological condition. premedicated or sedated during appointment.
• Need for medical consultation. • He should be given short appointment to pre-
vent undue tiring.
• History of any previous unpleasant esthetic ex-
perience. • Least possible amount of anesthesia should be
used.
• Specific drug sensitivity of the patient.
• Vasoconstrictors, although not contraindicated,
• The need for premedication or intraoperative should be kept at a minimum dose or eliminated
sedation. if necessary.
• The time to be allotted for procedure. • Patient may be given oxygen by nasal cannula
during procedure.
• The technique or method to be used.
• Prophylaxis with appropriate antibiotics should
• Choice of an anesthetic solution.
be given if indicated
• The need and quantity of vasoconstrictor.

On first visit patients pulse rate and blood pressure Respiratory System: Bronchitis, Bronchiectasis, Em-
should be taken. Brief medical history should be physema, Asthma
taken. It involves: Precautions

• CVS Status • Treatment should be given in afternoon.

• Any respiratory difficulties, nervous system • Preoperative medications such as adhesives,

disorder, metabolic deficiencies, endocrine im- hypnotics and narcotics should be used with
balance, hematological pathologies & iatro- extreme caution as they interfere with cough
genic conditions reflex and depress ventilation.

CMRO 03 (07), 537−548 (2020) CURRENT MEDICAL RESEARCH AND OPINION 544
 Jaan A et al.
CURRENT MEDICAL RESEARCH AND OPINION
• Bronchodialators, nebulizers and expectorants
can be given preoperatively. Effect of Inflammation on LA (2): Inflammation and
• Choice of local anesthetic or vasoconstrictor is infection lowers the tissue pH , altering the ability
not of utmost importance provided there are no of a LA to provide clinically adequate pain control.
other complicating pathologies. There are two methods of obtaining adequate nerve
block are:
• Oxygen can be given by nasal cannula if re- 1. Administer LA away from the area of inflamma-
quired during dental procedure. tion: It helps in preventing the spread of infection to
uninvolved regions. It also provides adequate pain
control because of presence of more normal tissue
Metabolic diseases
condition. Regional nerve block anesthesia is the
(1) Diabetes Precautions Severity of diabetes. major factor in pain control for pulpally involved
teeth.
• Evaluate the patient treatment whether di- 2. Deposit a larger volume into the region : It will
abetes is controlled by diet/hypoglycemic provide a greater no. of uncharged base molecule to
agents/insulin. diffuse through the nerve sheath to give satisfactory
nerve block. Some patients respond unfavorably to
• Patient controlling diabetes by diet pose no instrumentation of their root canal, even when canals
problem. are debrided thoroughly.
• Patient on insulin should be treated between Solution : Infiltration, Intrapulpal anesthesia & Top-
9.00 am – 12pm because as a result of food and ical anesthesia: Can apply a small amount of topical
insulin intake, it is during these hours that they anesthetic ointment onto the file or reamer prior to
are best able to tolerate stressful situations. inserting it into the canal.
Recent Advances in Local Anesthetics and some Ad-
(2) Hypothyroidism ditions in Lidocaine to Improve its Properties
These patients do not metabolize drug as well as the
normal individual therefore doses of vasoconstric- Centbucridine: It is quinolone derivativewhich is 5-
tors in drug should be kept minimum because of 8 times potent than Lidocaine. It does not effect
relative CVS conditions. CNS or CVS adversely except when higher doses
(3) Hyperthyroidism administered. (28) Vacharajani et al (1983) proved
Physician consultation that efficacy of 5% of Centbucridine is same as that
of 2% Lidocaine. (29)
• Well premedication/sedation Oraqix : A recently introduced locally applied anes-
thetic gel, is a eutectic mixture of prilocaine & lido-
• Vasoconstrictor should be reduced. caine each in a 2.5% concentration. It was approved
by FDA in 2004. (30)
Local Anesthesia in Pregnancy & Postpartum (27) Ropivacaine : It is a long acting amide having lower
Local anesthetics can be safely used when treating arrhythmogenic potential than Bupivacaine. It has
pregnant & postpartum patients if careful guidelines low toxicity and available in 0.75%, 0.2% concen-
are followed . Because teratogenic risks are highest tration. (31)
in the first trimester, the 2nd trimester is usually the Electronic Dental Anesthesia: Anesthesia (Elec-
period chosen for routine dental care. Lidocaine is tronic Dental Anesthesia or EDA) which works by
least associated with medical complications. transcutaneous electrical nerve stimulation (TENS)
LA Consideration in Endodontics was introduced to the dental profession. (32) One

CURRENT MEDICAL RESEARCH AND OPINION CMRO 03 (07), 537−548 (2020) 545
LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

study has favored its use as its efficacy in pain 6. Af Eckenstam B, Egner B, Petterson G. Acta
control has been described as comparable to local Chem Scand 1957;11: 1183.
anaesthesia while at the same time avoiding the
possible side effects associated with commonly used
7. Manzano GM, Giuliano LMP, Nobrega JAM. A
local anaesthetic agents and the inconvenience of
post-operative anaesthetic effect. (33) Another study brief historical note on the classification of
suggested EDA could be indicated for needle-phobic nerve fibres. Arq Neuropsiauiatr 2008;66(1):
children; however, studies that have tested its effec- 117-19.
tiveness in children are few. (34)
8. Benett CR. Monheimʼs local anesthesia and
pain control in dental practice. 7th ed, BD
2 SUMMARY & CONCLUSION: Decker, Inc, Ontario Canada.

The science of LA is an active research field and 9. Tucker GT. Pharmacokinetics of local
LA will continue to be one of the mainstays of
anesthetics. Br J Anaesth 1986;58: 717-31.
contemporary perioperative medicine. Anxiety, fear
& apprehension should be recognized & managed
before administration of a local anesthetic. Vasocon- 10. Moore PA, Hersh EV. Local Anesthetics :
strictors should be included in all local anesthetics Pharmacology and toxicity. Dent Clin N Am
unless specifically contraindicated. Partial resistance 2010;54: 587-99.
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nerve damage is very rare and LA-induced toxicity dental practice. 1st ed. Arya(Medi) Publishing
after peripheral nerve block has a good prognosis House, New Delhi 2008.
overall.
12. Howe GL. Local anaesthesia in dentistry. 3rd ed
Wright, London.
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CURRENT MEDICAL RESEARCH AND OPINION CMRO 03 (07), 537−548 (2020) 547
LOCAL ANESTHESIA - SOLUTION TO PAIN : AN OVERVIEW

How to cite this article: Jaan A., Munshi

R., Sareen K., Parmar E., Thakur P., Anindita
A. Local Anesthesia - Solution to Pain : An
Overview. Journal of Current Medical Research
and Opinion. 2020;537−548. https://doi.org/
10.15520/jcmro.v3i07.317

CMRO 03 (07), 537−548 (2020) CURRENT MEDICAL RESEARCH AND OPINION 548