Nerve Block Damage

Trigeminal nerve injuries related to local anaesthesia in dentistry

Injuries to inferior alveolar and lingual nerves are caused by local analgesia block injections and have an estimated injury incidence of between 1:26,762 to 1/800,000. Reports of incidences include 1:588,000 for Prilocaine and 1/440,000 for articaine IAN blocks which is 20-21 times greater than for lidocaine injections (Pogrel and Thamby, 2000; Haas and Lennon, 1995). 'Perhaps every full time practitioner will find he or she has one patient during his or her career who has permanent nerve involvement from an inferior alveolar nerve block and there is no means of prevention' (Pogrel and Thamby 2000). 

These injuries are associated with a 34% (Pogrel and Thamby, 2000) and 70% (Renton et al in press) incidence of neuropathic pain, which is high when compared with other causes of peripheral nerve injury. A recent settlement of U$1.4 million dollars (Main USA ) for lingual nerve injury caused by local analgesic IAN block highlights the recognition of the associated disability and social repercussions of these injuries.

If the nerve injury is temporary, recovery is reported to take place at eight weeks for 85-94% of cases (Smith and Lung 2006). IAN injuries may have a better  prognosis than lingual nerve injuries and if the duration of nerve injury is greater than eight weeks then permanency is a risk. However, the true incidence is difficult to gauge without large population surveys. The problem with these injuries is that the nerve will remain grossly intact, thus surgical exposure is not appropriate as one cannot identify the injured region. Pain management is necessary, as the unfortunate patient will have chronic neuropathic pain as a result of injury (Renton et al 2009 in press). 

In the US, liability claims and malpractice suits are inherent risks associated with iatrogenic nerve injury (Venta et al 2000), and the reasons for avoidance of such injury are obvious. Iatrogenic nerve lesions may produce symptoms ranging from next to nothing to a devastating affect on quality of life. Only few studies, however, describe the range of neurosensory disturbance in terms of signs and symptoms related to impaired nerve conduction and neurogenic affliction (Hillerup and Jenson 2006), and there is a need for better standardisation and documentation of sensory deficits resulting from nerve injuries and their recovery (Zuniga et al, 1999). Due to the incidence of nerve injuries in relation to dental anaesthesia, warning of patients is not considered routine, and indeed in the UK these iatrogenic injuries are not considered negligent.

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