Sunday, June 29, 2008

Stab Lab

You know something is going to be fun when it is affectionately referred to as stab lab. As a D-1, you hear about this experience quite early on, you know it is coming, and eventually it is upon you. Delivering anesthetic for the first time was an absolute positive experience. Don't let upper classmen horror stories convince you otherwise. No you don’t want to hurt your classmates, and yea, getting prodded and needled left and right doesn’t feel ‘good.’ But this is the first ‘doctorly’ thing you ever really do. You grab a giant syringe, load up your lidocaine, pry open your partners mouth, and slide that sucker on in, hoping to hit your mark.

We met up in groups of four in one of the school’s clinics. A brief demo is provided by the instructor, and then you pretty much just go stab happy. As easy as loading a syringe, capping and following all the safety precautions is, everyone is kinda clumsy and bumbling about.. it is the first time after all. I got to go first; I set everything up, administered the topical and took a stab at it…quite literally. We were going for inferior alveolar nerve blocks first. For those of you not in the know, a mandibular block injection or IAN (inferior alveolar nerve) block is a very common procedure performed in dental clinics across the world. Essentially, we deposit anesthetic around the IA nerve which will effectively cut off all sensation (aside from pressure) to half of the mandible. The anesthetic infiltrates the nerve fibers and blocks sodium channels from opening which consequently keeps the nerves from sparking action potentials (sending/receiving info).

The inferior alveolar nerve is a ways back, so we used a 27 gauge long needle. You palpate the coronoid notch of the mandible and pull the buccal mucosa taut so you can clearly see the pterygomandibular raphe. You inject just lateral to the raphe because the m. pteryoid muscle is just behind it. The major interior land mark is the lingula, a small hill of bone that crops up just anterior to the opening of the mandibular canal (which is where the IA nerve travels). The goal is to contact the lingula, re-angle slightly to cross over it, aspirate, and inject. Aspirating is a safety precaution to make sure the needle is not inserted in a blood vessel. The lingual nerve is also in close proximity so half of the tongue is commonly numbed up as well. It really isn’t that complicated, but even simple things feel difficult with zero experience. Sorry for all the technical babble, but this is helping me prepare for tests and the boards.

I needed to reinsert the needle a few times on my partner because I was failing to contact the lingula (or any bone for that matter). I was not aimed laterally enough, although I eventually found my target and provided a successful block. We next performed a much easier maxillary infiltration over the first pre-molar. An infiltration could be performed by a monkey. You just pull back the lip, and slightly stick the needle in just enough to get near the root apex. Easy.

Afterwards, we switched and I got jabbed by my partner. Note: never go out drinking the night prior to stab lab. Even if you aren’t hung over, your body will not enjoy being invaded and hopped up on lidocaine early the next morning. I felt a bit crappy for most of the day, but I attribute that to the drinking, because my partner did a good job. Shaving with a numbed face is pretty cool though. Aside from this, the entire experience went quite well.

In other news, I am studying for boards a lot still…trying to keep up with my classes…and practicing for a performance exam on Tuesday. Class IV composite restoration and Class III prep on #9. Pedo midterm on Thursday... fourth of july on the way.

I will be taking the boards before I know it