Postoperative bleeding, Reactionary and Secondary Haemorrhage

When you have closed an operation wound, there may start postoperative bleeding, reactionary and secondary haemorrhage. The type and reasons may be as follows:

Reactionary Haemorrage:

It occurs during the first 48 hours of the surgery. It may be due to a dislodged clot in a vessel, or a ligature has slipped.

Secondary Haemorrhage:

It occurs after 8 to 14 days after surgery. When the wound becomes infected and erodes a vessel. It may usually be quite a small one, but sometimes a larger one. One of the purposes of monitoring a patient immediately after an operation is to watch for reactionary haemorrhage, so make sure your staff observe him carefully, and take his pulse and blood pressure regularly.


Management of delayed haemorrhage:

If a patient's wound bleeds, apply firm local pressure and packing. If it bleeds rapidly, There may be a chance that an artery has been injured.

Minor bleeding probably comes from subcutaneous tissues, and is unlikely to be serious. If local pressure fails to control bleeding, take the patient back to the theatre and open his wound. Remove the sutures and tie or coagulate the bleeding vessels under local anaesthesia. Make sure the patient takes antibiotics.


Local Anaesthesia


  1. introduction to neurophysiology and Pharmacology
  2. Armamentarium
  3. Techniques of regional anaesthesia in dentistry
  4. Practice of local anaesthesia
  5. Complications legal considerations

Neurophysiology drugs and Pharmacology

  • fundamentals of nerve impulse generation and transmission
  • properties of local anaesthetic agents
  • theories of pain perception
  • mode of action of local anaesthetic agents
  • site of action of local anaesthetic agents
  • classification of local anaesthetic agents
  • Pharmacology of vasoconstrictors and local anesthetics


  • the syringe
  • the needle
  • the cartridge
  • the vial
  • additional armamentarium
  • preparation of armamentarium

Techniques of regional anaesthesia in dentistry

  • physical and psychological evaluation
  • basic injection technique
  • Anatomical consideration
  • techniques of maxillary anaesthesia
  • techniques of mandibular anaesthesia
  • supplemental injection techniques
  • local anaesthetic considerations in dental practice

Practice of local anaesthesia

  • medical evaluation
  • infection control
  • preanesthetic medication
  • newer injection technique
  • biomedical waste management

Complications and Medico-legal considerations

  • local complications and Management
  • systemic complications and its management
  • legal considerations


There are two often-confused words: analgesia and anaesthesia.

Analgesia is 'the removal of pain sensation' whereas anaesthesia is 'the loss of sensation in general' (including pain).

This difference in meaning is often missing, with many people as well as publications using the terminology 'local anaesthesia' when 'local analgesia' is what is meant.

Local analgesia is the effect that a dentist try to achieve in normal clinical activity; however, 'local anaesthesia' is the term commonly used in medicine and dentistry.

Local anaesthetics inhibit the generation of electrical impulses and their conduction along the neuronal axon membrane, by reversible blockade of sodium ion channels.

There is a continuous imbalance of sodium and potassium ions between the cytoplasm of neurons and the intercellular fluid.

This is maintained at about 25 times more potassium intracellularly and 15 times more sodium in interstitial space.

This imbalance is upheld through the sodium pump protein in the cell membrane, which maintains the resting membrane potential of -60 to -90 mv.  Action potentials are propagated along a neuron process through the rapid flux of ions against the resting gradient.

This results in a positive spike in the membrane potential that is dependent on the sodium pump.
Local anaesthetic drugs affect the movement of sodium ions across the membrane by blocking sodium channels.

However, this blockade can only happen from the intracellular side of the channel and thus a local anaesthetic drug is required to move through the cell membrane of the neuron before being able to block action propagation.

The progression of local anaesthetic block is dependant on nerve fiber diameter, myelination and conduction velocity.

Ref: Therapeutic guidelines 2008