Pharmacology, Anesthesia, and Pain Management
Core concepts
Know the pharmacology of local anaesthetics, including mechanism, onset, duration, and maximum doses of lidocaine, articaine, and prilocaine. Understand vasoconstrictors and their cautions in cardiovascular disease. Know the analgesics used in dentistry: paracetamol, NSAIDs, and opioids, and their indications and contraindications.
Anesthesia and pain
Master local anaesthetic techniques, including infiltration, inferior alveolar nerve block, and complications such as intravascular injection, nerve injury, and failure. Know the principles of conscious sedation and when general anaesthesia is indicated. Understand postoperative pain management and the role of multimodal analgesia.
Traps
Questions test maximum doses and the calculation for a given patient. Another trap is using adrenaline-containing anaesthetic in a patient with uncontrolled cardiovascular disease without caution. Do not prescribe antibiotics for pain alone. Know that aspirin is avoided in children and that NSAIDs are avoided in some renal and asthmatic patients.
Rule of thumb
Calculate the maximum dose from the patient's weight and the concentration of the solution before injecting; never exceed it.
Worked example
A 60 kg patient: lidocaine maximum is about 4.4 mg/kg, so roughly 264 mg, which corresponds to a limited number of cartridges; check before injecting multiple quadrants.