Your experiences on giving anesthesia injections to each other

[table]

Hey Guys,

As an up coming dental student I want to know your experiences with practicing on each other giving shots. I will be honest; I am kind of scared of it , especially to receive someone first shot. Let me know your experiences with your first time.



Thanks

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[Do You Endo]

youre joking right........

hmm... i guess not....

dont be scared, jump into it and act like youve got a head on your shoulder

 

[drengineer]

I'm scared of needles!!!
Oh maybe that's why i don't do drugs. Good, so the mystery is solved now!

 

[aphistis]

It sounds like a disaster waiting to happen, but really it'll end up being no big deal. You'll have faculty standing right over your shoulder to make sure everyone does it right. Best case scenario, your buddy gets it on the first try and you barely even feel it. The worst thing that could plausibly happen is having one side of your face go limp for a couple hours, and he'd have to *really* screw up a mandibular block for that to happen. We had 100 people give their first injections during our "stab lab," as we call it, and nobody had any problems. You'll be fine.

 

[Sk8aBull]

My biggest fear (next to spiders) is needles. I am completely dreading that day. My boyfriend has helped me a bit with this one... now I give him his medicine via injection, so I have no problems giving them. However, if he takes one in his hand and points in towards me like he is going to stick me, I completely freak out. I'm not so sure about how those days in d-school are going to fare, and I apologize in advance to whomever will be practicing on me...

 

[dentalman]

There are two things going on here:
1) Phobia of needles
2) Added fear because you realize that you don't know what you are doing and someone doing it on you may know even less.

For #1, I will tell you what I tell my patients. You will mainly feel just a little pinch at first, and if your student holds the tissue tight, you will barely feel it at all. Be sure to focus on your breathing. ( A lot of people hold their breath when they are stressed, and that isn't good.)

For #2, if you really lack confidence in your partner, they should understand, since they are in the same boat. Just quiz each other before hand. They can quiz you too so that they don't feel that it is simply a lack of trust in them. Have them explain in detail what angle they are going from , where they enter, what landmarks they use. If there is any doubt, just bring an instructor or fourth year dental student over for some explanation. Of course, if you have a true phobia, this may make things worse. But for me, that is where most of my anxiety lay - the other student not knowing what they are doing.

In fact, during my first experience, my partner gave me an IA that was more parallel to my ramus than perpendicular (in other words, went over the premolars on the same side of injection other than the opposite side - if this doesn't make sense, make sure to understand before your first try). I knew they were doing it wrong during the injection, but I couldn't really say anything because I didn't want to startle my partner. No facial drooping or hematoma (both of which go away). I just corrected them before they tried again.

 

[drhobie7]

I remember those days. Aahhhh. My buddy gave me a hematoma after trying several times to do a PSA. Not a big deal though. I had some intraoral swelling and soreness for a while. That's ok 'cause I stuck him right in the IAN! He jumped out of the chair and said it felt like an electric shock. Hehehehe, I gotcha! Anyway, neither one of these was a big deal, and both are rare. It may be the only time when giving is better than receiving.

 

[coral2005]

My biggest fear (next to spiders) is needles. I am completely dreading that day. My boyfriend has helped me a bit with this one... now I give him his medicine via injection, so I have no problems giving them. However, if he takes one in his hand and points in towards me like he is going to stick me, I completely freak out. I'm not so sure about how those days in d-school are going to fare, and I apologize in advance to whomever will be practicing on me...

OK... If you let me try on you, I'm pretty sure I won't hurt you. I'm pretty good at stuff like that. I've had some practice at giving injections to my dog...so I've lost that fear.

 

[Sprgrover]

Yes, I get nervous thinking about it. I've had a couple of terrible injections and I was sore for days - and that was at the hands of an experienced, licensed professional. The way my luck runs I'm sure who ever I get marooned with will be all thumbs that day and I'll end up addressing something like my lingual nerve to "see you later". Cold sweats, indeed.

 

[toofache32]

dont be scared, jump into it and act like youve got a head on your shoulder

...or a pair between your legs.

 

[drhobie7]

You guys should tell your instructors you want to practice V2 (pterygopalatine ganglion) blocks on each other. I've been wanting to try that one for a while. Every now and then I see one of the oral surgeons jab the needle into the posterior palate by the 2nd molar and bury it to the hub all in one quick stab. No poking around. Just straight into the greater palatine foramen. It's so badass. Maybe I can do that next time I do a class II Ag on a maxillary tooth.

 

[River83]

What a crazy thing! In my school (italian) we learn to do anesthesia directly to the patient...(or, are we odd??) i still remember my first mandibular block, done alone without any kind of help neither tecnical nor psycological.... and the results was a disaster.... it didn't work and i had to call the doctor....

Anyway my suggestion is to do a local anesthesia using Lidocain (i think tha in USA u called it Carbocain) cream at 5-10%... so you will not feel nothing.

On the other hand we performed EV iniections to each other... and i thing that they are worse...

 

[12YearOldKid]

Let's see... During our lab we had three pseudo Bell's palsies, a couple cases of palatal necrosis, permanent parasthesia, two kids with massive hematomas - one didn't resolve properly and requred surgical intervention. Some other little things.

But it's all just part of the game, I'm sure you'll be fine.

 

[toofache32]

You guys should tell your instructors you want to practice V2 (pterygopalatine ganglion) blocks on each other. I've been wanting to try that one for a while. Every now and then I see one of the oral surgeons jab the needle into the posterior palate by the 2nd molar and bury it to the hub all in one quick stab. No poking around. Just straight into the greater palatine foramen. It's so badass. Maybe I can do that next time I do a class II Ag on a maxillary tooth.

This is a great block. I do this on virtually all anterior maxillary abscesses where it's pointless to go for the infraorbital nerve because there's pus around it. I do a regular palatal block first, then I wait about 20 seconds. Then you can go in and probe around for the canal without bothering the patient. In my experience, the canal has been more distal and lateral than I expected.

 

[HermeytheElf]

When my dad was doing his stab lab in dental school, he was on the recieving end of a 27 gauge right though his lower lip...his lab partner was so focused on the spot where he was going to give the inferior alveolar that he wasn't watching and completely missed my dads mouth. But don't worry, I'm sure stuff like that never happens nowadays

 

[OMFSCardsFan]

Let's see... During our lab we had three pseudo Bell's palsies, a couple cases of palatal necrosis, permanent parasthesia, two kids with massive hematomas - one didn't resolve properly and requred surgical intervention. Some other little things.

But it's all just part of the game, I'm sure you'll be fine.

What jake-ass dental school did you go to?

 

[m-dmd]

You know what, most people that have never given an injection are scared, whether they admit to it or not. You are scared you are doing it right, you are scared you are going to hurt someone, you are scared that your prof is going to be an A-hole that day and give you a hard time, but you know what, you do it and you do it again and you do it again, and eventually your heart stops pounding (it will, I promise) and it will become second nature. I do it now, endlessly. The only ones that kill me are the rip roaring endo infections...thankfully those are rare.

Anyways, read, get prepared and do it. Nothing is better than experience.

 

[jes1ca]

i was pretty scared the first time, but it ended up being all right. just know your landmarks, find a partner you know and trust, get a professor to watch and it will be all right.

 

[Periogod]

Let's see... During our lab we had three pseudo Bell's palsies, a couple cases of palatal necrosis, permanent parasthesia, two kids with massive hematomas - one didn't resolve properly and requred surgical intervention. Some other little things.

But it's all just part of the game, I'm sure you'll be fine.

This is a normal day of clinic for OMFSCardsFan

 

[Sprgrover]

Let's see... During our lab we had three pseudo Bell's palsies, a couple cases of palatal necrosis, permanent parasthesia, two kids with massive hematomas - one didn't resolve properly and requred surgical intervention. Some other little things.

But it's all just part of the game, I'm sure you'll be fine.

Thanks for the pep talk!

 

[DcS]

I scored a direct hit...right into my buddy's IAN that sent an electric shock through his lower jaw and had him jump out of the chair about a foot. I guess I know my aim is good

The V2 is a nice one to know, though I'm a bit partial to Gow-Gates and Infraorbitals. Those two are the most fun to me.

 

[drhobie7]

ok here's my advice: just inject really fast and get it over with as quickly as possible.

 

[12YearOldKid]

Thanks for the pep talk!

I do what I can.

But truthfully, our injection clinic was pretty uneventful. No disfiguring hematomas, no sloughing of necrosed tissue, nada. I was just trying to keep the excitement up for you guys.

 

[12YearOldKid]

ok here's my advice: just inject really fast and get it over with as quickly as possible.

We were taught that a carpule should take 90-120 seconds to inject. I followed that rule up until the first time I assissted one of the residents in oral surgery. The resident slammed the lido in just as fast as that plunger would let him. Like 3 carpules in 15 seconds -- that includes switching the carpules out. Patient didn't know what hit him.

 

[12YearOldKid]

I've also all but given up on topical unless the patient asks for it. All it does is make the patient salivate and gag for 2 minutes so you have to keep suctioning.

Then the patient feels a little tingly and this gives them a false sense of security. They are thinking the injection isn't going to hurt so they are surprised when they feel the needle anyway. It makes it that much more uncomfortable in their mind.

I find I get far more compliments on painless injections when I use no topical. A well rehearsed story or constant conversation and gate control technique seem to work the best for me. I just do everything I can to distract patient from the fact that I am sinking a needle deep into his jaw.

In any case, do NOT do what I see so many of my classmates doing during injections. "How is that?" "This isn't hurting is it?" "Can you feel this?" What are you thinking people??!!!

Anybody have injection tips that work well for them?

 

[aphistis]

I scored a direct hit...right into my buddy's IAN that sent an electric shock through his lower jaw and had him jump out of the chair about a foot. I guess I know my aim is good

The V2 is a nice one to know, though I'm a bit partial to Gow-Gates and Infraorbitals. Those two are the most fun to me.

I like infraorbitals too. I've had good enough luck with the traditional IAN that I've never had to try a Gow-Gates. I was doing extractions for a lower immediate not too long ago and got positive aspirations on both IAN's...not quite as attention-getting as yours, but still a nice little validation.

 

[NavyDentistKC]

Hey Guys,

As an up coming dental student I want to know your experiences with practicing on each other giving shots. I will be honest; I am kind of scared of it , especially to receive someone first shot. Let me know your experiences with your first time.



Thanks

If they let you partner with someone, find someone you absolutely trust, who you won't feel stupid grimmacing or (heaven forbid) crying in front of; it hurts, but you'll live.

 

[duh?]

i was pretty scared the first time, but it ended up being all right. just know your landmarks, find a partner you know and trust, get a professor to watch and it will be all right.

Sorry to hijack this thread BUT, your post would work for a totally different, entirely freaky situation too. I just noticed that. LOL.

 

[duh?]

If they let you partner with someone, find someone you absolutely trust, who you won't feel stupid grimmacing or (heaven forbid) crying in front of; it hurts, but you'll live.

This too.

 

[SC-Z]

It won't be too terrible unless your partner hits your Inferior Alveolar nerver like my case. I almost jumped straight out of the chair.

 

[HermeytheElf]

I've also all but given up on topical unless the patient asks for it. All it does is make the patient salivate and gag for 2 minutes so you have to keep suctioning.

Then the patient feels a little tingly and this gives them a false sense of security. They are thinking the injection isn't going to hurt so they are surprised when they feel the needle anyway. It makes it that much more uncomfortable in their mind.

I find I get far more compliments on painless injections when I use no topical. A well rehearsed story or constant conversation and gate control technique seem to work the best for me. I just do everything I can to distract patient from the fact that I am sinking a needle deep into his jaw.

In any case, do NOT do what I see so many of my classmates doing during injections. "How is that?" "This isn't hurting is it?" "Can you feel this?" What are you thinking people??!!!

Anybody have injection tips that work well for them?

When you get out in private practice, give this a try (you'll have to have a pharmacy make it for you as noone I know of sells this yet): 10% lidocaine, 10% prilocaine, 4% tetracaine. This is the first topical that I know of that actually works...it's a bit expensive but completely worth it in the end.

On a side note, does your dental school let you use pressure syringes for palatals or do you have to do it the old fashioned way?

 

[12YearOldKid]

When you get out in private practice, give this a try (you'll have to have a pharmacy make it for you as noone I know of sells this yet): 10% lidocaine, 10% prilocaine, 4% tetracaine. This is the first topical that I know of that actually works...it's a bit expensive but completely worth it in the end.

On a side note, does your dental school let you use pressure syringes for palatals or do you have to do it the old fashioned way?

I've seen where a lot of dentists on DentalTown swear by that stuff. I definitely plan on trying some when I get out. But the stuff the school gives in the operative clinic is almost exactly the same as over-the-counter Anbesol. It does a great job of desensitizing that first quarter millimeter of mucosa --- too bad that's not where I'm giving my injection.

Pressure syringes? Sure, you just white knuckle the syringe handle and you get plenty of pressure.

 

[HermeytheElf]

I've seen where a lot of dentists on DentalTown swear by that stuff. I definitely plan on trying some when I get out. But the stuff the school gives in the operative clinic is almost exactly the same as over-the-counter Anbesol. It does a great job of desensitizing that first quarter millimeter of mucosa --- too bad that's not where I'm giving my injection.

Pressure syringes? Sure, you just white knuckle the syringe handle and you get plenty of pressure.

You should definitely get yourself a pressure syringe (that's what the dentist I work for calls them, maybe there's another name for them) when you graduate...it looks like a gun, but it adds alot of leverage and makes palatals a hell of alot easier on your hand. If you're still not sure what I'm talking about, here's a pic of one from patterson.
https://www.pattersondental.com/app.aspx?cmd=get_item&id=29727

 

[evamm]

I was at the clinic of my school when this patient came and was totally scared. I had to put anesthesia...so I told her, relax.... everything is going to be just fine...bla bla bla. She explained to me that she never had anesthesia before and she was completly nervous...so I said
Mrs...., why are you nervous? Look at me!...it is the first time that I will put anesthesia to a patient and I am not nervous!

 

[Sprgrover]

I was at the clinic of my school when this patient came and was totally scared. I had to put anesthesia...so I told her, relax.... everything is going to be just fine...bla bla bla. She explained to me that she never had anesthesia before and she was completly nervous...so I said
Mrs...., why are you nervous? Look at me!...it is the first time that I will put anesthesia to a patient and I am not nervous!

Let me guess, she calmed right down?

 

[evamm]

well....yeah.. she was at the clinic....she could not run or yell. After all she turned to be a good patient and I practiced more

 

[toofache32]

You should definitely get yourself a pressure syringe (that's what the dentist I work for calls them, maybe there's another name for them) when you graduate...it looks like a gun, but it adds alot of leverage and makes palatals a hell of alot easier on your hand. If you're still not sure what I'm talking about, here's a pic of one from patterson.
https://www.pattersondental.com/app.aspx?cmd=get_item&id=29727

That looks like a syringe for intraligamentary injections.

In the hundreds of patients I've blocked over the past several years, I have only had less than 5 patients that I couldn't get numb with traditional blocks. Those tended to be infections or supra-tentorial. If you find yourself relying on these toys then you're better off re-examining your technique and why you're missing the blocks. This includes hitting the mylohyoid nerve, etc. The nerves are there....you just have to hit them.

Just my 2 cents.

 

[duh?]

I was at the clinic of my school when this patient came and was totally scared. I had to put anesthesia...so I told her, relax.... everything is going to be just fine...bla bla bla. She explained to me that she never had anesthesia before and she was completly nervous...so I said
Mrs...., why are you nervous? Look at me!...it is the first time that I will put anesthesia to a patient and I am not nervous!

LOL! Oh lawd. That was funny.

 

[HermeytheElf]

That looks like a syringe for intraligamentary injections.

In the hundreds of patients I've blocked over the past several years, I have only had less than 5 patients that I couldn't get numb with traditional blocks. Those tended to be infections or supra-tentorial. If you find yourself relying on these toys then you're better off re-examining your technique and why you're missing the blocks. This includes hitting the mylohyoid nerve, etc. The nerves are there....you just have to hit them.

Just my 2 cents.

This "gadget" isn't a divining rod for finding cranial nerves nor does it claim to be...it's just made to reduce the amount of pressure required to give a palatal injection which ultimately increases the amount of control you have since you are more focused on where you're giving the injection and not on how tired your hand is getting from squeezing the syringe. You are correct that there is no substitute for good technique...the OP asked for tips on giving injections and I was merely suggesting this syringe as a way to make things easier on yourself and the patient.

 

[aphistis]

That looks like a syringe for intraligamentary injections.

In the hundreds of patients I've blocked over the past several years, I have only had less than 5 patients that I couldn't get numb with traditional blocks. Those tended to be infections or supra-tentorial. If you find yourself relying on these toys then you're better off re-examining your technique and why you're missing the blocks. This includes hitting the mylohyoid nerve, etc. The nerves are there....you just have to hit them.

Just my 2 cents.

I've only had one patient who I consistently have trouble properly anesthetizing. By process of elimination, I've pretty much concluded her IAN must come up from beneath her mandible somewhere, because it sure as heck doesn't come down from her skull base. I have to do PDLs for operative treatment, and God help the poor woman if she ever needs a mandibular extraction.

 

[drhobie7]

I've only had one patient who I consistently have trouble properly anesthetizing. By process of elimination, I've pretty much concluded her IAN must come up from beneath her mandible somewhere, because it sure as heck doesn't come down from her skull base. I have to do PDLs for operative treatment, and God help the poor woman if she ever needs a mandibular extraction.

You might need to use the supraocular approach and block the entire trigeminal ganglion. ....aaahhhhh.....

 

[DcS]

I've only had one patient who I consistently have trouble properly anesthetizing. By process of elimination, I've pretty much concluded her IAN must come up from beneath her mandible somewhere, because it sure as heck doesn't come down from her skull base. I have to do PDLs for operative treatment, and God help the poor woman if she ever needs a mandibular extraction.

Sounds like a good case for a Gow-Gates. Do you have a PAN? In my patient her canal openings were really high...almost at the coronoid level. Gow-Gates works well in her case. Only "tough" part is that there is no hard tissue target so you just bury.

 

[aphistis]

You might need to use the supraocular approach and block the entire trigeminal ganglion. ....aaahhhhh.....

Supra-ocular is for ninnies. I'm going trans, baby.

 

[aphistis]

Sounds like a good case for a Gow-Gates. Do you have a PAN? In my patient her canal openings were really high...almost at the coronoid level. Gow-Gates works well in her case. Only "tough" part is that there is no hard tissue target so you just bury.

Good call on the GG. I've never thought about using her as a guinea pig, but it can't turn out much worse than a conventional IAN. I'll add a note to look back at her films & try it next time she's in.

 

[ItsGavinC]

My bruising has almost disappeared from the IA I received from my anesthesia partner 12 months ago. Frickin' aspiration positive.