Journal of Dental Anesthesia and Pain Medicine

  • 제22권2호
  • /
  • Pages.145-153
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  • 2022
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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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Does dexmedetomidine combined with levobupivacaine in inferior alveolar nerve blocks among patients undergoing impacted third molar surgery control postoperative morbidity?

  • Patil, Shweta Murlidhar (Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University)) ;
  • Jadhav, Anendd (Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University)) ;
  • Bhola, Nitin (Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University)) ;
  • Hingnikar, Pawan (Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University)) ;
  • Kshirsagar, Krutarth (Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University)) ;
  • Patil, Dipali (The Grant Government Medical College, Nagpada, Mumbai Central)
  • 투고 : 2022.01.31
  • 심사 : 2022.03.03
  • 발행 : 2022.04.01
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초록

Background: Postoperative analgesia (POA) is an important determinant of successful treatment. Dexmedetomidine (DEX) has recently gained attention as a promising adjuvant to local anesthetics (LA). The present study aimed to evaluate the efficacy and safety of levobupivacaine (LB) as an adjuvant during inferior alveolar nerve block (IANB) in the extraction of lower impacted third molars (LITM). Methods: A prospective, randomized, placebo-controlled, triple-blind, parallel-arm, and clinical study was performed on 50 systemically healthy participants who required removal of an asymptomatic LITM. Using a 1:1 distribution, the participants were randomized into two groups (n = 25). Group L (control group) received 1.8 mL of 0.5% LB and 0.2 mL normal saline (placebo) and Group D (study group) received a blend of 1.8 mL of 0.5% LB and 0.2 mL (20 ㎍) DEX. The primary outcome variable was the duration of POA and hemodynamic stability, and the secondary variable was the total number of analgesics required postoperatively for up to 72 h. The participants were requested to record the time of rescue analgesic use and the total number of rescue analgesics taken. The area under the curve was plotted for the total number of analgesics administered. The pain was evaluated using the visual analog scale. Data analysis was performed using paired students and unpaired t-test, Mann-Whitney U test, Chi-square test, and receiver operating characteristic analysis. Statistical significance was set at P < 0.05. Results: The latency, profoundness of anesthesia, and duration of POA were statistically significant (P < 0.05). The differences between mean pain scores at 6, 12, 24, 48, and 72 h were found to be significant (each P = 0.0001). Fewer analgesics were required by participants in group D (2.12 ± 0.33) than in L (4.04 ± 0.67), with a significant difference (P = 0.0001). Conclusion: Perineurally administered LA with DEX is a safe, effective, and therapeutic approach for improving latency, providing profound POA, and reducing the need for postoperative analgesia.

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참고문헌

  1. Chaparro-Avendano AV, Perez-Garcia S, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Morbidity of third molar extraction in participants between 12 and 18 years of age. Med Oral Patol Oral Cir Bucal 2005; 1; 10: 422-31.
  2. Reddy KV, Jadhav A, Bhola N, Mishra A, Dakshinkar P. Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1: 80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?. Oral Maxillofac Surg 2019; 23: 225-31. https://doi.org/10.1007/s10006-019-00779-w
  3. Rao S, Rajan N. Dexmedetomidine as an adjunct for regional anesthetic nerve blocks. Curr Pain Headache Rep 2021; 25: 8. https://doi.org/10.1007/s11916-020-00926-z
  4. Gallego-Ligorit L, Vives M, Valles-Torres J, Sanjuan-Villarreal TA, Pajares A, Iglesias M. Use of dexmedetomidine in cardiothoracic and vascular anesthesia. J Cardiothorac Vasc Anesth 2018; 32: 1426-38. https://doi.org/10.1053/j.jvca.2017.11.044
  5. Gursoytrak B, Kocaturk O, Koparal M, Gulsun B. Comparison of dexmedetomidine and ketamine for managing postoperative symptoms after third-molar surgery. J Oral Maxillofac Surg 2021; 79: 532-6. https://doi.org/10.1016/j.joms.2020.10.020
  6. Bozorgi H, Zamani M, Motaghi E, Eslami M. Dexmedetomidine as an analgesic agent with neuroprotective properties: experimental and clinical aspects. J Pain Palliat Care Pharmacother 2021; 35: 215-25. https://doi.org/10.1080/15360288.2021.1914280
  7. Vorobeichik L, Brull R, Abdallah FW. Evidence basis for using perineural dexmedetomidine to enhance the quality of brachial plexus nerve blocks: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2017; 118: 167-81. https://doi.org/10.1093/bja/aew411
  8. Pan L, Wu H, Liu H, Yang X, Meng Z, Cao Y. Dexmedetomidine as an adjunct to local anesthetics in nerve block relieved pain more effectively after TKA: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2020; 15: 577. https://doi.org/10.1186/s13018-020-02105-7
  9. Khandaitkar S, Kolte V, Shenoi SR, Budhraja N. A clinical study to determine the efficacy of 7ppm dexmedetomidine as an adjuvant to 2% lignocaine in infraorbital nerve block. Br J Oral Maxillofac Surg 2016; 54: 997-1000. https://doi.org/10.1016/j.bjoms.2016.07.011
  10. Dcruz TM, Patel C, Masih A, Shaik I. A comparative study evaluating the efficacy of lignocaine and dexmedetomidine with lignocaine and adrenaline in third molar surgery. J Maxillofac Oral Surg 2020; 9: 1-5.
  11. Kumar P, Thepra M, Bhagol A, Priya K, Singh V. The newer aspect of dexmedetomidine use in dentistry: As an additive to local anesthesia, initial experience, and review of literature. Natl J Maxillofac Surg 2016; 7: 76-9. https://doi.org/10.4103/0975-5950.196137
  12. Ouchi K, Sugiyama K. Dexmedetomidine dose dependently enhances the local anesthetic action of lidocaine in inferior alveolar nerve block: a randomized double-blind study. Reg Anesth Pain Med 2016; 41: 348-55. https://doi.org/10.1097/AAP.0000000000000380
  13. Singh V, Thepra M, Kirti S, Kumar P, Priya K. Dexmedetomidine as an additive to local anesthesia: a step to development in dentistry. J Oral Maxillofac Surg 2018; 76: 2091.
  14. Alizargar J, Etemadi Sh M, Kaviani N, Wu SV, Jafarzadeh K, Ranjbarian P, et al. Injection of lidocaine alone versus lidocaine plus dexmedetomidine in impacted third molar extraction surgery, a double-blind randomized control trial for postoperative pain evaluation. Pain Res Manag 2021; 2021: 6623792.
  15. Nalawade SH, Nilesh K, Kumar CDM, Punde PA, Patil PB. A clinical comparative study of dexmedetomidine as an adjuvant to 2% plain lignocaine and 2% lignocaine with 1:200,000 adrenaline as local anesthetic agents for surgical removal of impacted mandibular third molars. Natl J Maxillofac Surg 2021; 12: 255-261. https://doi.org/10.4103/njms.NJMS_7_20
  16. Kosar S, Dar N, Hassan N, Shah AA. Use of dexmedetomidine in dentistry as an additive to local anesthesia in place of adrenaline. Int J Sci Res 2019; 10: 248-50.
  17. Basuni AS, Ezz HAA. Dexmedetomidine as supplement to low-dose levobupivacaine spinal anesthesia for knee arthroscopy. Egypt J Anaesth 2014; 30: 149-53. https://doi.org/10.1016/j.egja.2013.11.003
  18. Jyothi B, Govindaraj K, Pratishruthi, Shaikh SI. Comparison of analgesic efficacy of levobupivacaine, levobupivacaine and clonidine, and levobupivacaine and dexmedetomidine in wound infiltration technique for abdominal surgeries: a prospective randomized controlled study. Indian J Pain 2017; 31: 127-32. https://doi.org/10.4103/ijpn.ijpn_20_17
  19. Kataria AP, Jarewal V, Kumar R, Kashyap A. Comparison of levobupivacaine and levobupivacaine with dexmedetomidine in infraumbilical surgeries under spinal anesthesia. Anesth Essays Res 2018; 12: 251-5. https://doi.org/10.4103/aer.AER_227_17
  20. Esmaoglu A, Yegenoglu F, Akin A, Turk CY. Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block. Anesth Analg 2010; 111: 1548-51. https://doi.org/10.1213/ane.0b013e3181fa3095
  21. Biswas S, Das RK, Mukherjee G, Ghose T. Dexmedetomidine an adjuvant to levobupivacaine in supraclavicular brachial plexus block: a randomized double blind prospective study. Ethiop J Health Sci 2014; 24: 203-8. https://doi.org/10.4314/ejhs.v24i3.3
  22. Schulz KF, Altman DG, Moher D; CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010; 152: 726-32. https://doi.org/10.7326/0003-4819-152-11-201006010-00232
  23. Winter GB. Principles of exodontia as applied to the impacted mandibular third molar: a complete treatise on the operative technic with clinical diagnoses and radiographic interpretations. St. Louis, American medical book company. 1926.
  24. Pell GJ. Impacted mandibular third molars: classification and modified techniques for removal. Dent Dig 1933; 39: 330-8.
  25. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 1983; 17: 45-56. https://doi.org/10.1016/0304-3959(83)90126-4
  26. Klein RH, Alvarez-Jimenez R, Sukhai RN, Oostdijk W, Bakker B, Reeser HM, et al. Pharmacokinetics and pharmacodynamics of orally administered clonidine: a model-based approach. Horm Res Paediatr 2013; 79: 300-9. https://doi.org/10.1159/000350819
  27. Osunde OD, Adebola RA, Saheeb BD. A comparative study of the effect of suture-less and multiple suture techniques on inflammatory complications following third molar surgery. Int J Oral Maxillofac Surg 2012; 41: 1275-9. https://doi.org/10.1016/j.ijom.2012.04.009
  28. Cooper SA, Desjardins PJ. The value of the dental impaction pain model in drug development. Methods Mol Biol 2010; 617: 175-90. https://doi.org/10.1007/978-1-60327-323-7_15
  29. Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res 2011; 5: 128-33. https://doi.org/10.4103/0259-1162.94750
  30. Lu TL, Lu TJ, Wu SN. Effectiveness in block by dexmedetomidine of hyperpolarization-activated cation current, independent of its agonistic effect on α 2-adrenergic receptors. Int J Mol Sci 2020; 21: 9110. https://doi.org/10.3390/ijms21239110
  31. Yamane A, Higuchi H, Tomoyasu Y, Ishii-Maruhama M, Maeda S, Miyawaki T. Effect of dexmedetomidine injected into the oral mucosa in combination with lidocaine on local anesthetic potency in humans: a crossover double-blind study. J Oral Maxillofac Surg 2015; 73: 616-21. https://doi.org/10.1016/j.joms.2014.09.029
  32. Nooh N, Sheta SA, Abdullah WA, Abdelhalim AA. Intranasal atomized dexmedetomidine for sedation during third molar extraction. Int J Oral Maxillofac Surg 2013; 42: 857-62. https://doi.org/10.1016/j.ijom.2013.02.003
  33. Cai H, Fan X, Feng P, Wang X, Xie Y. Optimal dose of perineural dexmedetomidine to prolong analgesia after brachial plexus blockade: a systematic review and meta-analysis of 57 randomized clinical trials. BMC Anesthesiol 2021; 21: 233. https://doi.org/10.1186/s12871-021-01452-0