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yes agreed we dont use adrenaline on digital blocks anyway = a total contraindication where as dentists do on their end to prolong the anaesthesia .
There is NO reason what-so-ever to NOT use adrenaline in digital blocks, except in vasospastic conditions. ALL the evidence is clear that there is no risk. I have probably done close to 1000 digital blocks with adrenaline and NEVER had a problem.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
There is NO reason what-so-ever to NOT use adrenaline in digital blocks, except in vasospastic conditions. ALL the evidence is clear that there is no risk. I have probably done close to 1000 digital blocks with adrenaline and NEVER had a problem.
Teaching Ive just had = adrenaline = vaso constrictor = risk of vasular occlusion in the digit = gangrene= law suit= definate no no.
BUT
That could be driven by the " barrister in the cupboard" mentality over here (something I treat with suspicion and am not convinced is a reality in the real world unless it is accompanied by clinical stupidity / incompetance)
But
in all honesty clinically I dont know the answer to that ,in reality, you just have to go with what you have been taught and take heed of the warnings.
BUT
Why would you need to use adrenaline in a digital block ?? there are LA's that will numb a digit for 6 hours + without the need = why take the risk ?? just a thought
Cheers Fella
D
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
Teaching Ive just had = adrenaline = vaso constrictor = risk of vasular occlusion in the digit = gangrene= law suit= definate no no.
BUT
That could be driven by the " barrister in the cupboard" mentality over here (something I treat with suspicion and am not convinced is a reality in the real world unless it is accompanied by clinical stupidity / incompetance)
But
in all honesty clinically I dont know the answer to that ,in reality, you just have to go with what you have been taught and take heed of the warnings.
BUT
Why would you need to use adrenaline in a digital block ?? there are LA's that will numb a digit for 6 hours + without the need = why take the risk ?? just a thought
Cheers Fella
D
We teach the opposite as the most recent meta analysis/systematic review of ALL of the evidence on digital injections is that its NOT a problem.
The benefits of adrenaline = longer acting; less LA needed; less bleeding
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
It's important to note that self-aspirating does not mean automatically aspirating. It is very easy to use a self-aspirating syringe and not aspirate. As was mentioned in an earlier post the aspiration happens when you release the syringe. To aspirate you push on the plunger slightly, stretching the rubber membrane at the business end, then release pressure. You don't have to be able to pull back on the plunger to aspirate, as you would with a regular syringe. I currently use the Septodont Ultra Safety Plus XL syringes and I really like them, you can aspirate as described above or by pulling the plunger.
The release of the plunger on the modern self aspirating sryinge cartridge uses a back pressure and draws a flash of blood into the chamber in the sryinge as described above.
So it's the syringe, not the cartridge? What are differences in terms of the design of the actual cartridge itself? Or are all cartridges self-aspirating when placed into a self-aspirating syringe?
So it's the syringe, not the cartridge? What are differences in terms of the design of the actual cartridge itself? Or are all cartridges self-aspirating when placed into a self-aspirating syringe?
Yep.
None.
All cartridges can be used in a self aspirating system, as MJJ nicely explained. I use the same syringes. They're cool.
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
It's important to note that self-aspirating does not mean automatically aspirating. It is very easy to use a self-aspirating syringe and not aspirate. As was mentioned in an earlier post the aspiration happens when you release the syringe. To aspirate you push on the plunger slightly, stretching the rubber membrane at the business end, then release pressure. You don't have to be able to pull back on the plunger to aspirate, as you would with a regular syringe. I currently use the Septodont Ultra Safety Plus XL syringes and I really like them, you can aspirate as described above or by pulling the plunger.
This. The name is a little misleading. You don't have to actually draw back (well you can't!) but you do have to release the pressure on the plunger. The rubber relaxes and creates a very small negative pressure. So although its self aspirating you still have to stop and aspirate.
Thats not made it clearer at all!
Quote:
The digital blood vessels are smaller than the needle.
This also. Bit of common sense goes a long way.
Quote:
So it's the syringe, not the cartridge? What are differences in terms of the design of the actual cartridge itself? Or are all cartridges self-aspirating when placed into a self-aspirating syringe?
Its the design of the rubber bung which the syringe presses. When it gets pressed in it goes convex into the LA side and when you release the pressure it returns to flat. So far as I know all cartridges are designed this way.
We were taught both methods. The uni uses the self-aspirating syringes whereas where I was on NHS placement use normal syringes. Just as well that we were taught to aspirate as on the NHS placement, I aspirated whilst doing a digital block and had obviously hit a vessel as had blood draw back into the barrel! Can't remember the gauge of the needle though - sorry.
I prefer using the safety syringes now that I have got used to them but I did find them strange to start with. The main problem that I came across with the safety syringes was another student who has tiny hands and struggled to have the reach with her hands to use them.
This. The name is a little misleading. You don't have to actually draw back (well you can't!) but you do have to release the pressure on the plunger. The rubber relaxes and creates a very small negative pressure. So although its self aspirating you still have to stop and aspirate.
According to Septodont, as you can see in the video, you can draw back on the plunger. Unlike the usual stainless dental syringes the plunger in the Ultra Safety Plus forms a fairly tight seal against the interior wall of the cartridge. In theory if you draw back slowly you can aspirate. I've never tried it though, I always aspirate the other way, it's easier.
Do not use Lidocaine w/ epi on digital blocks. No need to and you "may" someday wish you hadn't.
Steve
__________________
DrSArbes
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
The digital blood vessels are smaller than the needle.
I didn't know that Craig. It's a good enough reason for me.
I was taught not to aspirate digital blocks and I don't in my clinic.
Tibial nerve block; obviously I do aspirate.
I use ordinary Scandonest (Mepivicaine) 3% Plain.
2 Cartridges/vials are drawn up in a 5ml disposable syringe (use a 21G needle for this part). If you insert the needle into the top of the glass vial, you can use the sheath of the needle to push down on the rubber-bung end of the vial, helping to empty it into the syringe.
Gives 4.4mls which is usually ample for a tibial nerve block.
Tap out any air bubbles prior to injecting. Use a 27G needle for delivery.
I didn't know that Craig. It's a good enough reason for me.
I was taught not to aspirate digital blocks and I don't in my clinic.
Tibial nerve block; obviously I do aspirate.
I use ordinary Scandonest (Mepivicaine) 3% Plain.
2 Cartridges/vials are drawn up in a 5ml disposable syringe (use a 21G needle for this part). If you insert the needle into the top of the glass vial, you can use the sheath of the needle to push down on the rubber-bung end of the vial, helping to empty it into the syringe.
Gives 4.4mls which is usually ample for a tibial nerve block.
Tap out any air bubbles prior to injecting. Use a 27G needle for delivery.
Job done.
If you use a ultra safety plus sryinge system and scandonest cartridges, there is no need to draw up the LA.
Cheers
D
"Political Correctness" is a doctrine, fostered by a delusional, illogical minority, and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is entirely possible to pick up a turd by the clean end
Personally I don't aspirate for a tibial nerve block nor a digital block.
Digital block for the same reason as Craig stated above (vessels are so small). For a tibial nerve block, if you hit the artery, you get an instant flashback of blood in the syringe. In actual fact, I will often 'look' for the artery in an overweight patient where the pulse is difficult to palpate. Even where the patient is under general anaesthesia and the blood pressure has dropped to the point where the pulse is non palpable or difficult to palpate, you still see a flashback when you are in the artery. It's the same for a popliteal nerve block although strangely I do aspirate for these purely out of habit even though the vessels are pretty far away from the nerves.
I'm quite used to the horrified response from students and visitors when they come to spend a day in theatre and see very little aspirating.
Ryan
The Following User Says Thank You to Ryan McCallum For This Useful Post:
I haven't aspirated for any local anesthetic block in the foot or ankle now for 29 years (ever since I started my surgical residency) except, sometimes, for PT nerve blocks. I tend to keep the needle moving during injections and don't stay in one place too long so I really don't see the point for the volumes of local I inject into the foot and ankle. If one knows the anatomy of the foot and ankle well, and has learned to palpate all the nerves of the foot and ankle (John Ruch, DPM), then I see no reason to aspirate for injections other than for the PT nerve block. http://www.worldcat.org/title/region...oclc/022768910
Here's the handout I made to teach the students and surgical residents on how to do ankle blocks, ala Dr. Ruch, when I was in my Biomechanics Fellowship at the California College of Podiatric Medicine.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Question: when you palpate the PT nerve, how do you know you havent simply 'rolled' a tendon (as they are in close proximity)?
When you palpate the posterior tibial (PT) nerve, the foot is held in dorsiflexion and eversion and the PT nerve can be palpated, moving your fingers from posterior-plantar to anterior-dorsal over the nerve (after lubricating the skin with isopropyl alcohol) as being the only structure that can be "plucked" like a thick and relative loose "guitar string". The PT tendon, on the other hand, is tightly held within the flexor retinaculum with dorsiflexion and eversion and is deeper and more anterior than the PT nerve. The PT nerve is more posteriorly located and has a very characteristic feel to it during this maneuver. The PT nerve is palpated posterior to the medial malleolus about 1 cm superior to the distal tip of the medial malleolus (see illustration in prior post).
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
thank you very much for that info. I have looked at your drawing and the area of 'insertion' is the same as the one i use, and I also tend to 'fan' and move the needle for deposition of the anaesthesia.
I should imagine palpating the nerve would add to the whereabouts of it quite significantly, however not so effective with swollen ankles or obese patients.
thank you very much for that info. I have looked at your drawing and the area of 'insertion' is the same as the one i use, and I also tend to 'fan' and move the needle for deposition of the anaesthesia.
I should imagine palpating the nerve would add to the whereabouts of it quite significantly, however not so effective with swollen ankles or obese patients.
Thank you again, Kevin.
great stuff
Peter:
Yes, this technque is not very easy to perform on patients with excessively swollen or fatty medial ankles. Practice makes perfect, as with learning any new technique.
__________________
Sincerely,
Kevin
**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Re: To Aspirate or Not
(something I treat with suspicion and am not convinced is a reality in the real world unless it is accompanied by clinical stupidity / incompetance) 
Re: To Aspirate or Not
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