• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.451-459
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• 2021

Background: Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. Methods: This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. Results: The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. Conclusion: Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.1
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• pp.1-8
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• 2023

Backgrounds: Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-in^TM) and the classic needle method during treatment-required infiltration anesthesia in children. Methods: This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05. Results: There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750). Conclusions: The needle-free injection system was as effective as the dental needle method. The Comfort-in^TM system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.2
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• pp.39-44
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• 2013

Most of the dental treatments have been routinely performed under the local anesthesia and the effectiveness has also been proved safe. However, even not frequently dentists face some complications associated with the local anesthesia. In this report, the experience of the paresthesia after mental nerve block anesthesia for an implant placement of the mandibular premolar was presented to raise awareness of the complications related with local anesthetic procedure and to discuss about the causes, the proper treatments and the preventive approach of the paresthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.183-190
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• 2017

Background: It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielberger's State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. Method: We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. Results: The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. Conclusion: It was possible to reduce the number of items in the STAI by focusing on "Preoperative anxiety before dental surgery."

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.1-10
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• 2019

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.31 no.2
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• pp.56-60
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• 2020

Vocal fold injections are usually performed with a patient wake in an office under local anesthesia. For comfortable and safe office-based procedures, thorough anesthesia and premedication should be provided to the following three regions; nasal cavity, oropharynx, and larynx. Topical lidocaine is most widely used anesthetics on office based procedure. Lidocaine has a low to intermediate potency, 45 minutes to 60 minutes' duration of action, and onset of sufficient anesthesia within 90 seconds of topical administration. Tetracaine, prilocaine, ropivacaine, and bupivacaine also have been used in the office-based procedures. Nasal decongestant, oxymetazoline, is also used for widening nasal cavity by constriction of nasal mucosa. The amount of topical and local anesthetics used in vocal fold injection rarely exceeds toxic doses. The physician should know proper anesthesia techniques and must be familiar with the safe dose and complication of all anesthetics used.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.181-189
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• 2019

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.87-96
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• 2022

This study aimed to assess the combined use of extraoral vibratory stimulation and extraoral cooling in reducing the pain (subjective and objective) of dental local anesthesia administration in children. PubMed, Cochrane Central Register of Controlled Trials, and Ovid SP databases were searched up to July 2021. Article titles were screened and full-text evaluations of the selected articles were performed. Finally, seven studies (391 children, aged 4 - 12 years) were included in this qualitative and quantitative analysis. The pooled data determined the combined effect of extraoral vibration and extraoral cooling as a single measure. Extraoral vibration or cooling alone were not compared. The measured primary and secondary outcomes were pain perception and subjective and objective pain, respectively. When compared with the control, extraoral vibration and cooling resulted in significant differences in the mean combined data for the variables, pain perception, and pain reaction. Children's subjective pain as measured by pain scores were reduced when extraoral vibration and cooling was used during local anesthesia administration (mean difference -3.52; 95% confidence interval [-5.06 - 1.98]) and objective pain (mean difference -1.46; 95% confidence interval [-2.95 - 0.02] ; mean difference -1.93; 95% confidence interval [-3.72 - 0.14]). Within the confines of this systematic review, there is low-quality evidence to support the use of combined extraoral vibration and cooling for reducing pain (subjective and objective) during intraoral local anesthesia administration in children.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.6
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• pp.357-365
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• 2020

Background: To evaluate the effectiveness of vibration as a counter-stimulatory measure in reducing subjective pain due to local anesthesia administration in children. Methods: Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched until April 2020. Studies were screened by titles and abstracts, followed by full text evaluation of the included studies. Results: A total of seven studies involving 376 children aged 5-17 years were included in the systematic review and meta-analysis. The meta-analysis compared vibration as a counter-stimulatory measure with no vibration as a comparator. The primary outcome evaluated was pain perception or subjective pain reported by the child. The secondary outcome evaluated was objective pain evaluated in each study. The pooled mean difference favored vibration to be effective for the first outcome. Conclusion: Within the limits of this systematic review, low quality evidence suggests that vibration as a counter-stimulatory measure is effective in reducing the subjective pain reported by children during local anesthesia administration.

• Journal of East-West Nursing Research
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• v.4 no.1
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• pp.7-20
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• 1999

Operation usually brings about psychological stress as well as physical stress to the patient and it greatly influences the maintenance of the homeostasis. Until now, most of the nursing research concerning the anxiety of the patient undergoing an operation has been done while the patient was under general anesthesia. Under local anesthesia, the anxiety of the patient who undergone operation is short. However, there is much demand of the operational nurses to mediate between the patient who is undergoing operation when fully conscious, as they are aware of the patient's anxiety and to decrease the patient's anxiety of this local anesthesia. Therefore, this research tries to verify the effects of the Hand-holding program on the anxiety of the operational patient undergoing local anesthesia and affirms the role of the nursing intervention. As an unequivalent control group non-synchronized designs, this research selects out 20 control groups and 21 experimental groups at random who have received cataract operation while under local anesthesia and after implementing the Hand-holding program to the experimental groups while undergoing the operation, the effect of the experiment was observed. By observing the Epinephrine, Cortisol, blood pressure, and pulse for the physical indexes before and after the enforcement of the hand-holding, and using the measurement of Speilberger(1972) for the psychological indicators for the anxiety of the patient before and after hand-holding, the results were analyzed through SAS program. As a results, intervention of hand-holding had a remarkable effect to decrease the anxiety felt by the patient and the diastolic blood pressure also was effectively decreased. On the other hand, through the decrease of the systolic blood pressure was also observed, it was not statistically significant. In the Epinephrine and Cortisol indicators, the intervention of hand-holding was revealed to have an insignificant effect. The Hand-holding was revealed to have an indicators, the intervention of Hand-holding was revealed to have an insignificant effect. The Hand-holding program may be said to have an effect which decreases the psychological anxiety of the patient undergoing local anesthesia.