Friday Questions: Emergency patient management with Dr. Koch

[Allen Ali Nasseh]

Drs. Koch and Nasseh respond to a question from the patient triage video.
[See the full post at: Friday Questions: Emergency patient management with Dr. Koch]

[rparmar]

Hi Dr.Nasseh:
So in my Endo residency…i didn’t learn this concept of Marcaine by itself being myotoxic. Is there any paper/material you can share…which explains more about it. So, if a patient comes to you for emergency Tx…and if we cannot provide Tx that day. Let’s suppose, it’s hot tooth #30 (S.I.P and S.A.P.). What is your protocol?
.Would give Lidocaine IANB + Lidocaine buccal infiltration followed by Marcaine buccal infiltration? How does lidocaine infiltration help in reducing Marcaine discomfort.
Thanks a lot
YOU ARE ABSOLUTELY A ROCKSTAR!

[rparmar]

So Sorry…Addition to the earlier question. I saw your video again.
So in the video you say…You like to give 3% Mepivacaine plain before Marcaine?

1) So for a hot #30, with a Dx of S.I.P.and S.A.P….What’s your protocol in regard to pre-anesthetic use of Mepivacaine followed by marcaine
2) Can Marcaine be be given as an IANB? My colleague endodontic resident gave it as a block, and patent was numb with paraesthesia for 2 days. 🙁
kind regards

[Allen Ali Nasseh]

@rparmar: mepivacain plain is only used as a pre-anesthesia. It’s role is to numb up soft tissue before giving any anesthesia with a catecolamine containing anesthetic that is typically more acidic and therefore more painful.
Myotonic quality of Marcaine and Bupivacaine has been known for a long time.
I don’t give Marcaine shots routinely. Only for this type of emergency care at the end of the day and for post op after surgery as it reduces inflammation.
Your friend’s parenthesis was Likey accidental. Normally 6-10 hours is what you would expect from a block.
For conventional RCT molar in mandible I give 1 block mepivacain plain as preamesthesia and two blocks of Septicaine with 1:100,000epi with one carpet Septocaine buffalo infiltration.
And no, worries Septocaine doesn’t cause paresthesia.
Cheers.

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