No

Local Anesthetic

Dental: Amide-type anesthetic used for local infiltration anesthesia; injection near nerve trunks to produce nerve block

B

Hypersensitivity to local anesthetics of the amide type

Aspirate the syringe after tissue penetration and before injection to minimize chance of direct vascular injection

Degree of adverse effects in the central nervous system and cardiovascular system are directly related to the blood levels of local anesthetic. The effects below are more likely to occur after systemic administration rather than infiltration.

Central nervous system: High blood levels result in anxiety, restlessness, disorientation, confusion, dizziness, tremors and seizures. This is followed by depression of CNS resulting in somnolence, unconsciousness and possible respiratory arrest. Nausea and vomiting may also occur. In some cases, symptoms of CNS stimulation may be absent and the primary CNS effects are somnolence and unconsciousness.

Hypersensitivity reactions: May be manifest as dermatologic reactions and edema at injection site. Asthmatic syndromes have occurred.

Psychogenic reactions: It is common to misinterpret psychogenic responses to local anesthetic injection as an allergic reaction. Intraoral injections are perceived by many patients as a stressful procedure in dentistry. Common symptoms to this stress are sweating, palpitations, hyperventilation, generalized pallor and a fainting feeling

No data reported

Local anesthetics bind selectively to the intracellular surface of sodium channels to block influx of sodium into the axon. As a result, depolarization necessary for action potential propagation and subsequent nerve function is prevented. The block at the sodium channel is reversible. When drug diffuses away from the axon, sodium channel function is restored and nerve propagation returns.

Infiltration:

Onset: ~2 minutes

Duration: Complete anesthesia for procedures lasting 20 minutes

Inferior alveolar nerve block:

Onset: ~3 minutes

Duration: ~2.5 hours

Children <10 years: Doses >40 mg (1 mL) as a 4% solution per procedure rarely needed

Children >10 years and Adults: Dental anesthesia, infiltration, or conduction block: Initial: 40-80 mg (1-2 mL) as a 4% solution; up to a maximum of 400 mg (10 mL) as a 4% solution within a 2-hour period. Manufacturer's maximum recommended dose is not more than 600 mg to normal healthy adults. The effective anesthetic dose varies with procedure, intensity of anesthesia needed, duration of anesthesia required and physical condition of the patient. Always use the lowest effective dose along with careful aspiration.

The following numbers of dental carpules (1.8 mL) provide the indicated amounts of prilocaine hydrochloride 4%.

1 cartridge: 72 mg prilocaine 4%

2 cartridges: 144 mg prilocaine 4%

3 cartridges: 216 mg prilocaine 4%

4 cartridges: 288 mg prilocaine 4%

5 cartridges: 360 mg prilocaine 4%

6 cartridges: 432 mg prilocaine 4%

7 cartridges: 504 mg prilocaine 4%

8 cartridges: 576 mg prilocaine 4%

Note: Adult and children doses of prilocaine hydrochloride cited from USP Dispensing Information (USP DI), 17th ed, The United States Pharmacopeial Convention, Inc, Rockville, MD, 1997, 139.

No data reported

No information available to require special precautions

No effects or complications reported

Prilocaine hydrochloride 4%, 1.8 mL cartridges, containers of 100

Jastak JT and Yagiela JA, "Vasoconstrictors and Local Anesthesia: A Review and Rationale for Use," J Am Dent Assoc, 1983, 107(4):623-30.

MacKenzie TA and Young ER, "Local Anesthetic Update," Anesth Prog, 1993, 40(2):29-34.

Wynn RL, "Epinephrine Interactions With Beta-Blockers," Gen Dent, 1994, 42(1):16, 18.

Yagiela JA, "Local Anesthetics," Anesth Prog, 1991, 38(4-5):128-41.