Dental Trauma or Infection Clinical Pathway, Emergency Department – Analgesia, Local Anesthesia, Anxiolysis and Sedation

Dental Trauma or Infection Clinical Pathway — Emergency Department

Analgesia, Local Anesthesia and Regional Pain Control

Consult Child Life for pre-procedural teaching and support.
Consider options for anxiolysis and regional pain control preferentially over sedation.

Analgesia

Medication Route Dose Additional Information
Acetaminophen Oral 15 mg/kg/dose Max: 650 mg
Ibuprofen Oral 10 mg/kg/dose Max: 600 mg
Fentanyl IN 1-2 mcg/kg/dose Max: 50-100 mcg

Local Anesthesia and Regional Pain Control

Medication Route Dose Additional Information
Lidocaine 1%
Lidocaine 1%, Buffered		 Injectable
Use 25 or 27 gauge needle, inject slowly		 Varies with procedure, degree of anesthesia needed, vascularity of tissue, duration of anesthesia required
  • Max: 0.45 mL/kg
  • Lidocaine 1% and sodium bicarbonate 9:1
  • Duration: 30 min to 1 hr
Lidocaine 1% with Epinephrine
  • Max: 0.7 mL/kg/DOSE
  • Equivalent to 7 mg/kg/DOSE
  • Not to exceed adult dose of 500 mg
  • Equivalent to 50 mL of lidocaine 1%
  • Duration: 2 hrs
2% Viscous Lidocaine Topical Enough to coat cotton tip applicator
  • Dry mucosa with 2x2 gauze prior to application
  • Hold in place for 5 mins

Anxiolysis and Procedural Sedation

See Procedural Sedation Pathway for medication recommendations.

Sedation only in consultation with ED Attending and Dental/OMFS due to higher risk of complications.