Journal of Dental Anesthesia and Pain Medicine

  • 제20권3호
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  • Pages.147-154
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  • 2020
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  • 2383-9309(pISSN)
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  • 2383-9317(eISSN)
대한치과마취과학회 (The Korean Dental Society of Anesthsiology)
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Post-operative analgesia of 2% lignocaine with or without magnesium sulfate for inferior alveolar nerve block in symptomatic mandibular molars - a randomized double blind controlled clinical trial

  • 투고 : 2020.02.03
  • 심사 : 2020.06.06
  • 발행 : 2020.06.30
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초록

Background: Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO4 in patients with symptomatic irreversible pulpitis and apical periodontitis. Methods: Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker-Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. Results: Administration of 150 mg MgSO4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. Conclusion: Combining 75 mg or 150 mg of MgSO4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO4 is adequate for endodontic procedures.

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참고문헌

  1. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics : Mechanisms and Management. Endodontic Topics 2002; 1: 26-39. https://doi.org/10.1034/j.1601-1546.2002.10103.x
  2. Malamed SF. Handbook of local anesthesia. 3rd ed. Philadelphia, Elsevier's Health Sciences. 1990, pp 1-332.
  3. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod 1998; 24: 487-91. https://doi.org/10.1016/S0099-2399(98)80053-8
  4. Boopathi T, Sebeena M, Sivakumar K, Harikaran J, Karthick K, Raj A. Supplemental pulpal anesthesia for mandibular teeth. J Pharm Bioallied Sci 2013; 5(Suppl 1): S103-8.
  5. Swain A, Nag DS, Sahu S, Samaddar DP. Adjuvants to local anesthetics: Current understanding and future trends. World J Clin Cases 2017; 5: 307-23. https://doi.org/10.12998/wjcc.v5.i8.307
  6. Ryu JH, Kang MH, Park KS, Do SH. Effects of magnesium sulphate on intraoperative anaesthetic requirements and postoperative analgesia in gynaecology patients receiving total intravenous anaesthesia. Br J Anaesth 2008; 100: 397-403. https://doi.org/10.1093/bja/aem407
  7. Narang S, Dali JS, Agarwal M, Garg R. Evaluation of the efficacy of magnesium sulphate as an adjuvant to lignocaine for intravenous regional anaesthesia for upper limb surgery. Anesth Intensive Care 2008; 36: 840-4. https://doi.org/10.1177/0310057X0803600614
  8. Shetty KP, Satish SV, Kilaru KR, Sardar P, Luke AM. Comparison of anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. J Endod 2015; 41: 431-3. https://doi.org/10.1016/j.joen.2015.01.003
  9. Catterall WA. From ionic currents to molecular mechanisms: the structure and function of voltage-gated sodium channels. Neuron 2000; 26: 13-25. https://doi.org/10.1016/S0896-6273(00)81133-2
  10. Hille B. Ion Channels of Excitable Membrane. 1st ed. Sunderland, MA, USA, Sinauer Assoc Publishers. 1984, pp 58-75.
  11. Larson CE. Methylparaben-an overlooked cause of local anesthetic hypersensitivity. Anesth Prog 1977; 24: 72-4.
  12. Ketabi M, Shamami MS, Alaie M, Shamami MS. Influence of local anesthetics with or without epinephrine 1/80000 on blood pressure and heart rate: A randomized doubleblind experimental clinical trial. Dent Res J (Isfahan) 2012; 9: 437-40.
  13. Rood JP. The nerve supply of the mandibular incisor region. Br Dent J 1977; 143: 227-30.
  14. Do SH. Magnesium : a versatile drug for anesthesiologists. Korean J Anesthesiol 2013; 65: 4-8. https://doi.org/10.4097/kjae.2013.65.1.4
  15. Houlihan S, Decarie D, Benes C, Cleve R, Vidler M, Magee LA. Magnocaine: Physical Compatibility and Chemical Stability of Magnesium Sulphate and Lidocaine Hydrochloride in Prefilled Syringes. J Obstet Gynaecol Can 2016; 38: 936-44. https://doi.org/10.1016/j.jogc.2016.04.097
  16. Lin S, Wigler R, Huber R, Kaufman AY. Anaesthetic efficacy of intraligamentary injection techniques on mandibular molars diagnosed with asymptomatic irreversible pulpitis: A retrospective study. Aust Endod J 2017; 43: 34-7. https://doi.org/10.1111/aej.12169
  17. Wolff HG, Hardy JD, Goodell H. Studies on pain. Measurement of the effect of morpine, codeine and other opiates on the pain threshold and analysis of their relation to the pain experience. J Clin Invest 1940; 19: 659-80. https://doi.org/10.1172/JCI101169
  18. Mumford JM. Pain perception threshold and adaptation of normal human teeth. Arch Oral Biol 1965; 10: 957-68. https://doi.org/10.1016/0003-9969(65)90089-0
  19. Koinig H, Wallner T, Marhofer P, Andel H, Horauf K, Mayer N. Magnesium sulfate reduces intra- and postoperative analgesic requirements. Anesth Analg 1998; 87: 206-10. https://doi.org/10.1213/00000539-199807000-00042
  20. Jaiswal R, Bansal T, Kothari S, Ahlawat G. The effect of adding magnesium sulphate to bupivacaine for spinal anaesthesia: a randomised, double-blind trial in patients undergoing lower limb orthopaedic surgery. Int J Pharm Pharm Sci 2013: 5: 179-82.
  21. Dube L, Granry JC. The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review. Can J Anaesth 2003; 50: 732-46. https://doi.org/10.1007/BF03018719
  22. Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium sulfate in postoperative analgesia. Anesthesiology 1996; 84: 340-7. https://doi.org/10.1097/00000542-199602000-00011
  23. Siqueira JF, Barnett F. Interappointment pain: mechanisms, diagnosis, and treatment. Endod Top 2004: 7: 93-109. https://doi.org/10.1111/j.1601-1546.2004.00062.x
  24. Ko SH, Lim HR, Kim DC, Han YJ, Choe H, Song HS. Magnesium sulfate does not reduce postoperative analgesic requirements. Anesthesiology 2001; 95: 640-6. https://doi.org/10.1097/00000542-200109000-00016
  25. Paech MJ, Magann EF, Doherty DA, Verity LJ, Newnham JP. Does magnesium sulfate reduce the short- and long-term requirements for pain relief after caesarean delivery? A double-blind placebo-controlled trial. Am J Obstet Gynecol 2006; 194: 1596-602. https://doi.org/10.1016/j.ajog.2006.01.009
  26. Tramer MR, Glynn CJ. An evaluationof a single dose of magnesium to supplement analgesia after ambulatory surgery: randomized controlled trial. Anesth Analg 2007; 104: 1374-9. https://doi.org/10.1213/01.ane.0000263416.14948.dc