You’ve been to the dentist, right? Yeah, me too.
February is right around the corner, and in honor of AVMA-sponsored National Pet Dental Health Month, this post is about making dental anesthesia easier for you and your animal patients by remembering to use regional anesthesia to eliminate pain before, during, and after oral surgery.
We sometimes forget that we have all experienced some degree of pain similar to what our animal patients might experience during a dental procedure. So we can draw on our own experiences to be proactive for the animals in our care. For instance, I have often recited the anesthesia mantra, “pain is easier to prevent than to overcome,” but all I really have to do is to remember that my dentist applies a regional nerve block inside my mouth before he fires up the drill. Despite the fact that I always steel myself against the needle’s approach, I appreciate his timing.
Regional nerve blocks contribute to multi-modal pain management by interrupting the impulse transmission along the pain pathway, which inhibits the pain response. One of the greatest benefits of a regional block is that we can maintain our patients at a much lighter plane of general anesthesia, thereby significantly reducing some risks associated with general anesthesia. When surgical pain is fully controlled with local anesthesia, we are able to use anesthetic gas for what it does best: patient restraint. Regional blocks also provide smoother recoveries because the pain impulse never reaches the cerebral cortex, so even when the animal is fully awake, there is no recognition of pain.
The internet and YouTube are full of tutorials on where and how to place regional anesthesia for dental procedures in animals. And by now we’ve all learned how to qualify sources and use the resources we find online appropriately. For this overview, I lean heavily on a 2014 article by Dr Brett Beckman entitled Nerve Blocks for Oral Surgery in Dogs. In the article, Beckman provides step-by-step technique with photographs, as well as drugs, dosages, do’s-and-don’ts, and tips. Whether your role is to place the blocks or to assist, Beckman’s article is worth the read.
Tools of the Trade
One of the beautiful things about regional nerve blocks for oral surgery is that you don’t need any special equipment to place them. Here’s your short list of supplies to gather.
- Syringe (sized to the infusion volume)
- Fine gauge needles
- Local anesthetic of choice
- Bupivacaine is a long-acting anesthetic frequently used for regional anesthesia. Interestingly, a 2016 study showed that adding buprenorphine to the bupivacaine significantly increased the time many animals were pain free.
- Optional: a canine skull or other visual guide to anatomic landmarks
- I always used Miller’s Guide to the Dissection of the Dog
Types of Nerve Blocks
Nerve blocks are commonly used in four regions of the oral cavity. Beckman suggests that the nomenclature for these blocks is confusing in that the name of a block may refer to the region that it blocks or it may be named according to the actual nerve that is blocked. He offers a simplification and clarification of nomenclature to describe the region affected rather than the nerve blocked. Beckman describes the four most common blocks as follows:
- Rostral maxillary block
- Known as infraorbital block
- Affects bone, teeth, and soft tissue in the mouth from the maxillary third premolar rostral to the mid-line.
- Caudal maxillary block
- Affects bone, teeth, and soft tissue in the mouth from the last molar rostral to the mid-line, including the soft and hard palates.
- Rostral mandibular block
- Known as mental block
- Affects bone, teeth, and soft tissue in the mouth from the mandibular second to third premolar rostral to the mid-line.
- Caudal mandibular block
- Known as inferior alveolar block
- Affects bone, teeth, and soft tissue in the mouth from the mandibular third molar rostral to the mid-line.
Whether you are placing nerve blocks yourself or assisting someone else, remembering to use this valuable tool will enhance patient safety during the surgery and patient comfort afterward. Local blocks are easy to administer and require no special equipment to perform. Their use is paramount in providing the best patient care for oral surgery.
Ken Crump AAS, AHT is a writer and animal anesthetist, and writes Making Anesthesia Easier for DarvallVet, a division of Advanced Anesthesia Specialists. He makes dozens of Continuing Education presentations on veterinary anesthesia and oncology across the United States and in Canada. Ken retired from the Veterinary Teaching Hospital at Colorado State University in 2008