Why after giving 3 times of inferior dental and lingual,long buccal nerve block ,pain occur extracti

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Don't give Anesthesia more than maximum dose , In case of infection there is acidic pH of tissue, and in that case local anesthetics are mostly in ionized form .Ionized form of local anesthetics is the one that binds to sodium channels, but non-ionizide form is the one that is important for membrane penetration. That is the reason for delayed onset of local anesthetics in site of infection. On the other hand, if you add NaHCO3 to local anesthetic, there will be more non ionizide form of anesthetic which will contribute to better membrane  penetration, and faster onset of anesthesia.

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Good to know something from Dr. Abrar Ahmed Khan

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