J Korean Dent Soc Anesthesiol.  2001 Jun;1(1):26-31. 10.17245/jkdsa.2001.1.1.26.

Primary Closure of Deep Penetrating Wounds under Local Anesthesia with Dental Lidocaine HCL 28 Ampules in Maxillofacial Regions: Report of Two Cases

• Kim JB
• Yoo JH

• KMID: 2345197
• DOI: http://doi.org/10.17245/jkdsa.2001.1.1.26

Abstract

The wide deep penetrating wound of maxillofacial region should be early closed under emergency general anesthesia for the prevention of complications of bleeding, infection, shock & residual scars. But, if the emergency general anesthesia wound be impossible because of pneumoconiosis, obstructive pulmonary disease & hypovolemic shock, early primary closure should be done under local anesthesia by use of much amount of the anesthetic solution. The maximum dose of dental lidocaine (2% lidocaine with 1 : 100,000 epinephrine) is reported to 7 mg/kg under 500 mg (13.8 ampules) in normal adult. But the maximum permissible dose of dental lidocaine can be changed owing to the general health, rapidity of injection, resorption, distribution & excretion of the drug. The blood level of overdose toxicity is above 4.0µg/ml in central nervous & cardiovascular system. The injection of dental lidocaine 1-4 ampules is attained to the blood level of 1µg/ml in normal healthy adult. The duration of anesthetic action in the dental 2% lidocaine hydrochloride with 1 : 100,000 epinephrine is 45 to 75 minutes and the period to elimination is about 2 to 4 hours. Therefore, authors selected the following anesthetic methods that the first injection of 6 ampules is applied into the deeper periosteal layer for anesthetic action during 1 hour, the second injection into the deeper muscle & fascial layer, the third injection into the superficial muscle and fascial layer, the fourth injection into the proximal skin & subcutaneous tissue and the fifth final injection into the distal skin & subcutaneous tissue. The total 26-28 ampules of dental lidocaine were injected into the wound as the regular time interval during 5-6 hours, but there were no systemic complications, such as, agitation, talkativeness, convulsion and specific change of vital signs and consciousness.

Keyword

Emergency care; Maxillofacial injury; Lidocaine; Local anesthesia; Penetrating wound

MeSH Terms

Adult
Anesthesia, General
Anesthesia, Local*
Cardiovascular System
Cicatrix
Consciousness
Dihydroergotamine
Emergencies
Emergency Medical Services
Epinephrine
Hemorrhage
Humans
Lidocaine*
Lung Diseases, Obstructive
Maxillofacial Injuries
Pneumoconiosis
Seizures
Shock
Skin
Subcutaneous Tissue
Vital Signs
Wounds and Injuries
Wounds, Penetrating*
Dihydroergotamine
Epinephrine
Lidocaine