Is superficial thrombophlebitis a serious condition. How is superficial thrombophlebitis diagnosed. What are the most effective treatments for superficial thrombophlebitis. Can superficial thrombophlebitis be prevented.

Understanding Superficial Thrombophlebitis: An Overview

Superficial thrombophlebitis is a medical condition characterized by inflammation and swelling of a vein just below the skin’s surface, typically resulting from a blood clot. This condition often occurs following the use of an intravenous (IV) line or after trauma to the vein. While generally considered a benign and short-term issue, superficial thrombophlebitis can cause discomfort and concern for those affected.

The condition typically manifests with symptoms such as pain and tenderness along the affected vein, as well as a hardened, cord-like feeling beneath the skin. In most cases, these symptoms subside within one to two weeks, although the hardness of the vein may persist for an extended period.

Visual Manifestation of Superficial Thrombophlebitis

One of the telltale signs of superficial thrombophlebitis is the appearance of erythema, or redness, following the vascular pattern on the affected area. This is particularly noticeable on the lower extremities, where the superficial veins become inflamed and dilated, resulting in visible discoloration of the skin.

Causes and Risk Factors of Superficial Thrombophlebitis

Superficial thrombophlebitis can develop due to various factors. Understanding these causes and risk factors is crucial for both prevention and management of the condition.

Common Causes of Superficial Thrombophlebitis

• Injury to the vein
• Intravenous medication administration
• Predisposition to blood clots

Risk Factors Associated with Superficial Thrombophlebitis

1. Cancer or liver disease
2. Deep vein thrombosis
3. Inherited blood clotting disorders
4. Infections
5. Pregnancy
6. Prolonged periods of inactivity or sitting
7. Use of birth control pills
8. Presence of varicose veins

Can certain medical conditions increase the risk of developing superficial thrombophlebitis. Indeed, individuals with cancer, liver disease, or a history of deep vein thrombosis are at a higher risk. Additionally, inherited blood clotting disorders can predispose a person to this condition.

Recognizing the Symptoms of Superficial Thrombophlebitis

Identifying the symptoms of superficial thrombophlebitis is crucial for early detection and prompt treatment. The condition presents with several distinct signs that patients and healthcare providers should be aware of.

Key Symptoms to Watch For

• Skin redness and inflammation along a vein just below the skin’s surface
• Tenderness or pain in the affected area
• Warmth emanating from the site of inflammation
• Pain in the affected limb
• Hardening of the vein, often described as a cord-like sensation

Do the symptoms of superficial thrombophlebitis always manifest in the same way. While the above-mentioned symptoms are common, the severity and combination of symptoms may vary from person to person. Some individuals might experience all of these symptoms, while others may only notice a few.

Diagnostic Approaches for Superficial Thrombophlebitis

Accurate diagnosis of superficial thrombophlebitis is essential for appropriate treatment and management. Healthcare providers employ various methods to confirm the condition and rule out other potential issues.

Primary Diagnostic Methods

1. Physical examination: The primary method of diagnosis, based on the appearance of the affected area
2. Monitoring of vital signs: Regular checks of pulse, blood pressure, temperature, skin condition, and blood flow
3. Ultrasound imaging: Used to confirm the condition and assess the extent of vein involvement
4. Culture tests: If infection is suspected, skin or blood cultures may be performed

Is ultrasound imaging always necessary for diagnosing superficial thrombophlebitis. While ultrasound is a valuable tool for confirming the diagnosis and assessing the extent of the condition, it may not be required in all cases. The decision to use ultrasound typically depends on the severity of symptoms and the healthcare provider’s clinical judgment.

Treatment Options for Superficial Thrombophlebitis

The management of superficial thrombophlebitis aims to alleviate discomfort, reduce inflammation, and prevent complications. Treatment approaches can vary depending on the severity of the condition and individual patient factors.

Conservative Management Strategies

• Elevation of the affected limb above heart level
• Application of warm compresses to the affected area
• Use of support stockings for leg involvement
• Removal of catheters or IV lines if they are the cause of thrombophlebitis

Pharmacological Interventions

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling reduction
2. Anticoagulants in cases where deeper vein clots are present
3. Antibiotics for treating associated infections

Surgical and Interventional Approaches

In some cases, more invasive treatments may be necessary, particularly for large varicose veins or to prevent recurrence in high-risk individuals. These may include:

• Surgical removal (phlebectomy) of the affected vein
• Vein stripping
• Sclerotherapy

Are all cases of superficial thrombophlebitis treated the same way. No, treatment approaches are tailored to the individual patient’s needs, considering factors such as the severity of symptoms, the extent of vein involvement, and the presence of any underlying conditions or risk factors.

Prognosis and Long-Term Outlook for Superficial Thrombophlebitis

Understanding the prognosis and long-term outlook for superficial thrombophlebitis can help patients manage their expectations and adhere to treatment plans effectively.

Typical Course of the Condition

• Generally considered a short-term condition
• Symptoms often resolve within 1 to 2 weeks
• Hardness of the affected vein may persist for an extended period

Does superficial thrombophlebitis lead to serious complications. In most cases, superficial thrombophlebitis does not cause significant complications. However, in rare instances, it can progress to deeper veins, potentially leading to more serious conditions such as deep vein thrombosis. Regular follow-ups with healthcare providers are essential to monitor the condition’s progression and prevent any potential complications.

Prevention Strategies for Superficial Thrombophlebitis

While not all cases of superficial thrombophlebitis can be prevented, there are several strategies that individuals can employ to reduce their risk of developing this condition.

Lifestyle Modifications for Prevention

1. Maintaining regular physical activity to promote healthy blood circulation
2. Avoiding prolonged periods of sitting or standing
3. Elevating legs when resting, especially for those with varicose veins
4. Wearing compression stockings, particularly during long periods of inactivity (e.g., long flights)

Medical Considerations for Prevention

• Proper management of underlying conditions that increase clotting risk
• Careful consideration of birth control options for those at higher risk
• Regular check-ups and vein health assessments for individuals with a history of vein issues

Can lifestyle changes significantly reduce the risk of developing superficial thrombophlebitis. Yes, adopting a healthy lifestyle that promotes good circulation and vein health can play a crucial role in preventing superficial thrombophlebitis. Regular exercise, maintaining a healthy weight, and avoiding prolonged periods of immobility are all effective strategies for reducing risk.

Superficial Thrombophlebitis in Special Populations

Certain groups of people may be at higher risk for developing superficial thrombophlebitis or may require special considerations in terms of management and treatment.

Pregnancy and Superficial Thrombophlebitis

Pregnant women are at an increased risk of developing superficial thrombophlebitis due to hormonal changes and increased blood volume. Management of the condition during pregnancy requires careful consideration to ensure the safety of both the mother and the developing fetus.

Superficial Thrombophlebitis in Cancer Patients

Individuals with cancer may be more susceptible to superficial thrombophlebitis due to the hypercoagulable state associated with malignancies. Additionally, frequent use of intravenous lines for cancer treatments can increase the risk of developing this condition.

Elderly Patients and Superficial Thrombophlebitis

Older adults may be at higher risk for superficial thrombophlebitis due to decreased mobility, increased prevalence of varicose veins, and higher likelihood of underlying medical conditions that predispose them to clotting disorders.

How does the management of superficial thrombophlebitis differ in these special populations. Treatment approaches may need to be adjusted based on the specific needs and risk factors of each group. For example, pregnant women may require alternative anticoagulation strategies, while cancer patients might need more frequent monitoring and preventive measures.

Emerging Research and Future Directions in Superficial Thrombophlebitis Management

As medical knowledge continues to advance, new research and treatment modalities for superficial thrombophlebitis are emerging. These developments hold promise for improved diagnosis, management, and prevention of the condition.

Advancements in Diagnostic Techniques

• Development of more sensitive imaging techniques for early detection
• Exploration of biomarkers for predicting thrombophlebitis risk

Novel Treatment Approaches

1. Investigation of new anticoagulant medications with improved safety profiles
2. Research into targeted therapies for reducing inflammation in affected veins
3. Exploration of minimally invasive interventional techniques for severe cases

Preventive Strategies and Risk Assessment

Ongoing research is focusing on developing more accurate risk assessment tools and personalized prevention strategies for individuals at high risk of superficial thrombophlebitis.

Will these emerging research areas lead to significant improvements in superficial thrombophlebitis care. While it’s difficult to predict the exact impact of ongoing research, the continued focus on understanding the mechanisms of superficial thrombophlebitis and developing new treatment modalities holds promise for improved patient outcomes in the future.

As our understanding of superficial thrombophlebitis continues to evolve, healthcare providers and patients alike can look forward to more effective, personalized approaches to managing this condition. By staying informed about the latest developments and working closely with healthcare teams, individuals affected by superficial thrombophlebitis can optimize their treatment outcomes and overall vein health.

Superficial thrombophlebitis Information | Mount Sinai

Thrombophlebitis – superficial

Thrombophlebitis is a swollen or inflamed vein due to a blood clot. Superficial refers to veins just below the skin’s surface.

Superficial thrombophlebitis is an inflammation of a vein just below the surface of the skin, which results from a blood clot. This condition may occur after recently using an IV line, or after trauma to the vein. Some symptoms can include pain and tenderness along the vein and hardening and feeling cord-like. Superficial thrombophlebitis is usually a benign and short-term condition. Symptoms generally subside in 1 to 2 weeks, but hardness of the vein may remain for much longer.

Shown here is erythema following the vascular pattern on a lower extremity. The superficial veins have become inflamed and dilated, causing the discoloration.

Causes

This condition may occur after injury to the vein. It may also occur after having medicines given into your veins. If you have a high risk for blood clots, you may develop them for no apparent reason.

Risks for thrombophlebitis include:

• Cancer or liver disease
• Deep vein thrombosis
• Disorders that involve increased blood clotting (may be inherited)
• Infection
• Pregnancy
• Sitting or staying still for a prolonged period
• Use of birth control pills
• Swollen, twisted, and enlarged veins (varicose veins)

Symptoms

Symptoms may include any of the following:

• Skin redness, inflammation, tenderness, or pain along a vein just below the skin
• Warmth of the area
• Limb pain
• Hardening of the vein

Exams and Tests

Your health care provider will diagnose this condition based mainly on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and blood flow may be needed.

Ultrasound of the blood vessels helps confirm the condition.

If there are signs of an infection, skin or blood cultures may be done.

Treatment

To reduce discomfort and swelling, your provider may recommend that you:

• Wear support stockings, if your leg is affected.
• Keep the affected leg or arm raised above heart level.
• Apply a warm compress to the area.

If you have a catheter or IV line, it will likely be removed if it is the cause of the thrombophlebitis.

Medicines called NSAIDs, such as ibuprofen, may be prescribed to reduce pain and swelling.

If clots in the deeper veins are also present, your provider may prescribe medicines to thin your blood. These medicines are called anticoagulants. Antibiotics are prescribed if you have an infection.

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein may be needed. These treat large varicose veins or to prevent thrombophlebitis in high-risk people.

Outlook (Prognosis)

This is usually a short-term condition that does not cause complications. Symptoms often go away in 1 to 2 weeks. Hardness of the vein may remain for much longer.

Possible Complications

Complications are rare. Possible problems may include the following:

• Infections (cellulitis)
• Deep vein thrombosis

When to Contact a Medical Professional

Contact your provider for an appointment if you develop symptoms of this condition.

Also contact your provider if you already have the condition and your symptoms worsen or do not get better with treatment.

Prevention

In the hospital, swollen or inflamed veins can be prevented by:

• The nurse regularly changing the location of your IV line and removing it if swelling, redness, or pain develop
• Walking and staying active as soon as possible after surgery or during a long-term illness

When possible, avoid keeping your legs and arms still for long periods. Move your legs often or take a stroll during long plane trips or car trips. Try to avoid sitting or lying down for long periods without getting up and moving about.

Cardella JA, Amankwah KS. Venous thromboembolism: prevention, diagnosis, and treatment. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1072-1082.

Wasan S. Superficial thrombophlebitis and its management. In: Sidawy AN, Perler BA, eds. Rutherford’s Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 150.

Last reviewed on: 5/10/2022

Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Pain, Inflammation and a Nodule After IV Medication

Vol. 13 •Issue 7 • Page 21
Pain, Inflammation and a Nodule After IV Medication

by Andrew Craig, NP

Elizabeth, a 20-year-old college student, presented to the student health center where I work in January 2005. She reported having a painful vein on her right forearm since an intravenous medication injection a month prior. She had gone home over the Christmas break, become ill with gastroenteritis and sought medical treatment in the emergency department of a large teaching hospital near her home.

She received intravenous promethazine (Phenergan) and recalled that it burned considerably as it was administered. Elizabeth said that when she mentioned this to the staff member giving her the medication, the person told her she was “fine” and that she should apply warm compresses to the area if her discomfort persisted.

By the time she presented to the student health center, Elizabeth had been following this regimen for a month without relief and still had a tender, hard area on the vein above her right wrist. Her pain was constant and moderate in severity, made worse by contact and only slightly better with the warm compresses. She said she recently noticed a “knot” on her right arm just below her elbow.

Elizabeth had no fever, chills, shortness of breath, chest pain or cough. She reported no injury to the area. Her past medical history was unremarkable; she took no medications other than oral contraceptives and had no drug allergies. She was a nonsmoker.

Exam and Diagnostic Tests

On exam, Elizabeth was alert, afebrile and in no distress. On the dorsal aspect of her distal right forearm were two swollen, tender, inflamed areas along the track of her basilic vein. One area was approximately 4 cm long and just proximal to her right wrist. The other was approximately 1 cm long and just proximal to the first inflamed segment. I palpated a 0.5-cm, somewhat firm nodule on the dorsal proximal right forearm about 2 cm distal to the medial condyle. This appeared similar to the epitrochlear node but was not in the classic position for it.

I diagnosed Elizabeth with superficial phlebitis. Since she reported no history of gastrointestinal bleeding or ulcers, I prescribed oral naproxen sodium (Naprosyn) 500 mg every 12 hours with food. I also instructed her to take one 81-mg enteric-coated aspirin daily for its antiplatelet properties and wrote a referral for venous Doppler study to rule out thrombophlebitis. I instructed her to continue the warm compresses 4 to 6 times daily and to elevate her arm as much as possible. I further instructed her to report to the emergency department should she develop any shortness of breath, chest pain or hemoptysis. She was discharged home with further follow-up to be determined once the Doppler study results were in.

Elizabeth had her Doppler study a week later, and the results indicated a localized venous thrombosis in the right basilic vein just distal to the elbow. The radiologist noted that a superficial vein on the dorsum of the right hand demonstrated marked wall thickening but had good flow and compressibility, probably due to chronic thrombophlebitis. Based on these results, I referred Elizabeth to a local surgeon who evaluated her and instructed her to return for local excision in 2 months if the clot did not resolve.

Epidemiology

Superficial thrombophlebitis occurs frequently, yet it does not get much attention in the literature.¹ This lack of attention is probably because the condition is often relatively mild and self-limiting. The list of risk factors is long (Table 1).

In contrast to deep vein thrombosis (DVT), which may result from hereditary blood disorders or chronic illness, superficial thrombophlebitis is typically the result of trauma (e.g., IV insertion and infusion of irritating medicines) or infection.^1,2 This condition is common, occurs most frequently in young to middle-aged adults, and is slightly more frequent in women. ¹

Superficial thrombophlebitis does not typically cause significant morbidity or mortality unless the condition extends to the deep venous system. When this occurs, it can be the source of a pulmonary embolus (PE). Superficial thrombophlebitis is an acute inflammatory condition. Unlike DVT (which is typically not associated with inflammation), superficial thrombi adhere firmly to the inside of vessel walls and generally do not form emboli.^3,4

Patients with thrombophlebitis frequently have alterations in one or more components of Virchow’s Triad: damage to the intimal wall of the vessel, venous stasis and altered coagulation.⁴ In this case, Elizabeth probably developed intimal damage as a result of the peripheral intravenous catheter. She had also received intravenous promethazine, and this nausea medication can induce the formation of antiphospholipid antibodies, another risk factor for thrombophlebitis.⁵

Differential Diagnosis

Signs and symptoms of superficial thrombophlebitis include tenderness, warmth and heat along the course of the affected vein, along with swelling in the affected extremity. ^1,3,5 The vein may have a palpable cord or knot. Table 2 lists differential diagnoses.

Examination should include the affected area, the regional lymph nodes and a cardiovascular exam if you suspect PE. Measurement of extremity circumference will objectively quantify any limb swelling. Measure at the same point on both extremities. I typically choose a bony landmark and measure from that landmark to the area of greatest circumference. I make sure that I measure from that same point on the other extremity. For example: “Arm circumference was 20 cm on the left and 18 cm on the right, measured 10 cm distal to the lateral condyles.”

Diagnostic tests distinguish thrombophlebitis from phlebitis and rule out thrombi of the deep venous system. Additional tests may be needed to evaluate for pulmonary embolism if DVT is present or you suspect PE. Several tests are available:²

Compression ultrasonography. This is the noninvasive test of choice; it uses sound waves to generate pictures inside an extremity and can identify superficial and deep thrombi. The patient in this case had this test.

Contrast venography. Although venogram is the gold standard, this is no longer the initial study of choice because of its invasive nature. The test involves threading a catheter into the affected vein and injecting contrast dye, which enables veins (and clots) to show up on x-ray.

Magnetic resonance imaging. Although not as widely used as venography and ultrasound, this may be useful when the patient cannot tolerate intravenous dye (e.g., dye allergy, pregnancy, renal failure).

While blood tests for coagulation disorders and blood dyscrasias are indicated in cases of DVT, my review of the literature did not find a similar recommendation for cases of uncomplicated superficial thrombophlebitis.

When PE is a concern, relevant diagnostic tests include ventilation or perfusion lung scanning, spiral CT of the chest and serum d-dimer level.

Treatment

Most cases of superficial thrombophlebitis are self-limiting and respond to conservative measures. Warm compresses and nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays of therapy.

While aspirin may be of benefit as an NSAID, its use as an antiplatelet agent is of little benefit because superficial thrombophlebitis is due to inflammation and fibrin clot, not platelet aggregation.¹

Anticoagulants (e.g., heparin), while useful in the management of DVT, are not typically used in superficial cases of thrombophlebitis. Removal of an offending intravenous catheter and initiation of antibiotics are indicated in cases of thrombophlebitis caused by infection. Culture the catheter tip to identify the specific bacteria involved.

Follow-Up and Referral

Symptoms that do not resolve after 4 weeks require follow-up. In such cases, refer the patient to a general or vascular surgeon for excision of the clot under local anesthesia. Patients also should return if their symptoms worsen or if additional thrombi form, and they should seek emergency care for any signs or symptoms of pulmonary embolus (chest pain, shortness of breath, tachypnea, cough or hemoptysis).

References

1. Johnson G Jr. Superficial thrombophlebitis. eMedicine 2005. Available at: http://www.emedicine.com/med/topic3201.htm.

2. Lip GY, Pineo GF, Bauer KA. Patient information: venous thrombosis. UpToDate 2005. Available with subscription at: http://www.utdol.com.

3. Beers MH (ed.) Superficial thrombophlebitis. In The Merck Manual of Medical Information Online (2^nd ed.) 2004. Available at: http://www.merck.com/mmhe/sec03/ch036/ch036c.html.

4. McMorran J, Crowther DC, McMorran S, et al. Superficial vein thrombosis. GPnotebook 2005. Available at: http://www.gpnotebook.co.uk/simplepage.cfm?ID=275447823.

5. Bauer KA, Lip GY. Evaluation of the patient with established venous thrombosis. UpToDate 2005. Available with subscription at: http://www.utdol.com.

Andrew Craig, NP, is a family nurse practitioner at The University of North Carolina-Charlotte’s Student Health Center and an NP in the U. S. Naval Reserve. He is also a member of the ADVANCE for Nurse Practitioners editorial advisory board and is the journal’s technology consultant.

Table 1: Risk Factors for Thrombophlebitis^1,2,4

• Previous surgery

• Pregnancy

• Obesity

• Age older than 60 years

• Use of oral contraceptives, hormone replacement therapy or tamoxifen

• Immobilization, extended travel (“economy class syndrome”)

• Smoking

• Presence of an intravenous catheter

• Injection of caustic or irritating substances

• Previous thromboembolism

• Chronic medical conditions such as heart failure, renal disease or cancer

• Blood disorders such as polycythemia vera

• Elevated blood homocysteine; positive antiphospholipid antibodies

Table 2: Differential Diagnosis¹

• Cellulitis

• Suppurative thrombophlebitis, a serious condition associated with intravenous infection and septicemia, manifested by purulence in the affected vein

• Migratory thrombophlebitis, recurrent, progressive thrombi along the course of a vein, usually in the lower extremities, associated with carcinoma

pain after injections is fraught with danger

Yulia Sycheva

© URA. RU News Service

An abscess may form at the injection site, noted Galina Slobodina
Photo: Ekaterina Sychkova © URA.RU

Swelling, redness in the area of ​​intramuscular injection, as well as a possible rise in temperature, indicate that an abscess has formed on the site and urgent intervention by the surgeon is necessary. The therapist, rheumatologist, integrative medicine doctor, nutritionist, candidate of medical sciences Galina Slobodina told about this in an interview with URA.RU.

“If there is swelling in the area where the intramuscular injection was given, some incomprehensible swelling, redness, God forbid, the temperature has risen, then you need to unconditionally go to the surgeon. In some cases, the formed abscess has to be opened and the suppuration of the substrate is evacuated from there. Because sometimes when pierced, a certain amount of blood enters the vessels. This promotes suppuration. 24 hours after the injection is enough to see a doctor. You don’t need to wait for it to resolve, you shouldn’t try to make iodine nets, it’s useless here, ”explained Galina Slobodina.

According to the therapist, the cause of prolonged pain after intramuscular injections may be a violation of the needle insertion technique and the accumulation of medication. “Competent nurses know about the special upper outer quadrant on the gluteus muscle, that it is necessary to inject there. There is a special intermuscular space where the medicine is heated. We encounter all sorts of complications when people give themselves intramuscular injections on their own or ask relatives. Because if they do not fall into this quadrant, then the medicine will have nowhere to accumulate. This is the first moment. Secondly, if the drug is denser, for example, Milgamma, it can linger longer in this space and more slowly disperse into the blood. If there is no redness, swelling, then it is enough to rub the area several times, ”recommended Slobodina.

In an interview with URA. RU, the chief physician of the NAKFF medical clinic, an anesthesiologist-resuscitator Leonid Karev emphasized that pain and numbness in the injection area may indicate damage to the nerve ending. “If pain at the injection site is accompanied by numbness, then it may be the result of damage to the nerve ending. If it acquires a persistent aching and pulling character, then you need to contact a neurologist. There are also a number of diseases and conditions that are accompanied by poor wound healing. These are diabetes mellitus, anemia, atherosclerosis, chronic diseases of the cardiovascular system and lungs. Separate cases are presented by patients who are undergoing antitumor therapy, ”he added.

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Gums hurt after injection, pain relief, anesthesia

10/28/2018

• What causes gum pain after an injection?
• What to take to get rid of the pain from the injection?
• Folk remedies for pain in the gums.

Most dental procedures are accompanied by injection pain relief to help people avoid pain and discomfort. The action of anesthesia ends after a couple of hours, leaving no traces at the injection site. Sometimes it is expressed by swelling of the gums, the appearance of discomfort and soreness that haunts the patient for up to several days. Then you should immediately visit a specialist.

A quality injection is used in almost every procedure. Often one of the following methods is used:

• Infiltration – an injection close to the focus of inflammation.
• Conduction – anesthesia of the nerve trunk zone, allowing up to 10 hours to “freeze” periodontal tissues.

Accuracy and quality of treatment does not exclude the problem of pain in the gums after the injection. This is the norm, since the periodontal tissue is damaged by the needle. For 24 hours, a pulling sensation after a visit to the dentist should not cause concern.

Pain after an anesthetic injection – the main causes

The patient’s response to anesthesia will depend on his sensitivity threshold and age category. Its duration varies from 2 hours to several days. If gum pain at the injection site persists for longer, you should consult your doctor.

The following complications are common:

1. Abscess (suppuration) is an infection of soft tissue, the characteristic symptoms are swelling, burning and painful throbbing.
2. A hematoma is an injury to a small capillary that has resulted in the collection of blood under the mucosa and the formation of a dark-colored bulge or lump.
3. Injury of the nerve trunk – a violation of the nerve fibers due to the needle entering the sensitive ending, which leads to the spread of pain to the cheek, temporal lobe and behind the ear.
4. Postoperative pain radiation. To remove an abscess in the tooth root or fistula, it seems that the gum hurts in the injection area.

The most serious cause of pain is the death of the mucosa. Necrosis can be caused by:

• Too rapid administration of anesthesia;
• Error in calculation and increased dose of adrenaline;
• Circulatory problems as a result of a chronic disease;
• Administration of drugs capable of initiating mucosal rejection.

How to relieve pain after an injection in the gum?

Taking antibiotics will stop inflammation in the jaw and slow down infection. Experts recommend: Lincomycin; Amoxiclav; Sumamed.

To eliminate the side effect and protect the intestines, prebiotics and probiotics (Linex, Bifidumbacterin or Bifiform) are prescribed in parallel.

The intensity of pain affects the choice of a drug that stops the attack for a long time.