• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.6
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• pp.323-341
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• 2019

Background: Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials. Methods: Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality. Results: Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia. Conclusion: Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.3
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• pp.135-141
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• 2023

Background: The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar. Methods: Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min. Results: Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05). Conclusion: According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.

• Archives of Plastic Surgery
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• v.43 no.3
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• pp.272-277
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• 2016

Background One-per-mil tumescent solution, which contains 0.2% lidocaine with 1:1,000,000 epinephrine, has been reported to be clinically effective for hand surgery under local anesthesia. However, it was lacking in its basic pharmacokinetics profile in regard to the onset of action (OOA) and duration of action (DOA). Methods A randomized, double-blind study was conducted on 12 volunteers who met the inclusion criteria from October to November 2014. All volunteers had their right and left ring finger pulps injected with either one-per-mil solution or 2% lidocaine. Semmes-Weinstein and two-point discrimination tests were used to test sensation. Visual analogue scale was recorded at the time when the finger lost its sensation and when it regained normal sensation to measure the OOA and DOA. The data were then analyzed with a paired t-test and a Wilcoxon signed-rank test. Results The OOA and DOA of 2% plain lidocaine were 1 minute and 99.67 minutes, respectively. Meanwhile, 0.2% lidocaine in a one-per-mil tumescent solution showed an OOA of 5 minutes and a DOA of 186.83 minutes. The OOA of 0.2% lidocaine in a one-per-mil tumescent solution is statistically shorter than 2% plain lidocaine (P=0.04); while its DOA is statistically longer than 2% plain lidocaine (P<0.001). Conclusions The 0.2% lidocaine in a one-per-mil tumescent solution is statistically and clinically superior to 2% plain lidocaine in achieving longer duration of local anesthesia.

• The Journal of the Korean dental association
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• v.56 no.1
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• pp.42-48
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• 2018

INTRODUCTION The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in two separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analogue scale pain scores obtained immediately after surgical extraction were primarily evaluated for the two groups receiving different epinephrine concentrations. Visual analogue scale pain scores obtained 2, 4, and 6 h after administering an anesthetic, onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the two groups. RESULTS There were no statistically significant differences between the two groups in any measurements except hemodynamic factors (P > .05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine ($P{\leq}01$). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

• Journal of Periodontal and Implant Science
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• v.39 no.sup2
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• pp.239-251
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• 2009

Purpose: Full-mouth disinfection enables to reduce the probability of cross contamination from untreated pockets to treated ones, for completing the entire SRP under local anesthesia with chlorhexidine as a mouth wash in two visits within 24 hours. This study aimed to compare the clinical effects of modified full-mouth disinfection (Fdis) after 6 months with those of conventional SRP (cSRP). Methods: Thirty non-smoking chronic periodontitis subjects were randomly allocated two groups. The Fdis group underwent the entire SRP under local anesthesia in two visits within 24 hours, a week after receiving supragingival scaling. A chlorhexidine (0.1%) solution was used for rinsing and subgingival irrigation for Fdis. The cSRP group received SRP per quadrant under local anesthesia at one-week intervals, one week after they had received scaling. Clinical parameters were recorded at baseline, after 1, 3 and 6 months. Results: There are significant (P<0.05) decreases in the sulcus bleeding index, and plaque index, and the increases in gingival recession were significantly smaller with Fdis after six months compared with cSRP. There was significant improvement in the probing depth and clinical attachment level for initially medium-deep pockets (4-6mm) after Fdis compared with cSRP. Multi-rooted teeth showed significantly larger attachment gain up to six months after Fdis. Single-rooted teeth showed significantly more attachment gain, 1 and 6 months after Fdis. Conclusions: Fdis has more beneficial effects on reducing gingival inflammation, plaque level, probing depth, gingival recession and improving clinical attachment level over cSRP.

• Journal of The Korean Dental Society of Anesthesiology
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• v.2 no.2 s.3
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• pp.107-113
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• 2002

Hyperventilation is defined as ventilation in excess of that required to maintain normal blood $PaO_2$ and $PaCO_2$. It is produced by several distinct causes: anxiety, respiratory alkalosis, increased blood catecholamine levels, and a decrease in the level of the ionized calcium in the blood. The dental fears about acute pain, needle, drill and dental surgery lead to the severe anxiety and increased blood catecholamine level. Therefore, the most dental patient should be cared gently as the stress reduction protocol. In spite of the gentle care, two cases of hyperventilation were occurred during local anesthesia for incision and drainage of acute odontogenic infectious lesions. We suggest that the dental patients with acute odontogenic infection must be attention for the manifestation of hyperventilation, especially in the medically compromised conditions.

• The Journal of the Korean dental association
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• v.58 no.7
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• pp.404-411
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• 2020

This study reports the unusual complications of 22-year-old male who presented with sudden hearing loss after the right mandibular third molar extraction under local anesthesia with 3.6 ml of 2 % lidocaine. Total 8.75 mg of oral dexamethasone for 1 week immediately after extraction was prescribed in department of oral and maxillofacial surgery but hearing did not improve after 1 week. As referral to otolaryngology, total 600 mg of oral methylon and hyperbaric oxygen therapies were operated for 2 weeks. The hearing of patient was improved at 6 weeks after extraction but tinnitus was persisted even after 12 months. The reason and treatment were discussed with literature review, searching with the keywords ['hearing loss' AND ('dental' OR 'tooth extraction'OR'teeth extraction')] in PubMed and Google scholar at October 2019. Total five cases were reported after tooth extraction with local anesthesia. The sudden hearing loss could be associated with local anesthesia containing vasoconstrictors. Early steroid (extensive medication and intra-tympanic injection) and hyperbaric oxygen therapies were recommended within 2 weeks. As a proper treatment, hearing could be improved but other additional symptoms, such as tinnitus, dizziness, might be remained.

• Journal of Korean Academy of Nursing
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• v.29 no.1
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• pp.97-106
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• 1999

This study was designed to investigate the effect of a hand massage program on anxiety and immune function in patients during cataract surgery. The hand massage program, in this study, consisted of hand massage and hand-holding. The subjects were sixty-three patients, thirty for the experimental and thirty-three for the control group, who were admitted at Kang Nam St. Mary's Hospital for cataract surgery. This study was carried out from December 10, 1997 to February 26, 1998. The level of anxiety as measured by the Visual Analogue Scale, systolic blood pressure, diastolic blood pressure, and pulse rate were measured before, after hand massage, and after hand-holding. Epinephrine, norepinephrine, cortisol, blood sugar levels, neutrophil, lymphocyte, and natural killer cell percentages also were measured before hand massage and five minutes before the end of the operation. Data were analyzed by t-tests, ANCOVA, repeated measures ANOVA, and Bonferroni multiple comparisons. The results were as follows : 1) After hand massage, psychological anxiety levels decreased significantly compared with before hand massage in the experimental group, not in the control group. After hand holding, there were significant decrease in both groups. 2) There were not significant differences on systolic blood pressure, diastolic blood pressure, and pulse rates in both groups. 3) The hand massage program decreased epinephrine, norepinephrine, and cortisol significantly in the experimental group, and increased epinephrine, norepinephrine, and cortisol in the control group. 4) There were no differences in blood sugar levels, neutrophil and lymphocyte percentages in white blood cells after the hand massage program. However, natural killer cells in lymphocytes were significantly increased in the experimental group. These findings indicate that a hand massage program could be a effective nursing intervention in decreasing the psychological and physiological anxiety levels and improving immune function in clients having cataract surgery under local anesthesia.

• Research in Community and Public Health Nursing
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• v.14 no.3
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• pp.407-414
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• 2003

Purpose: The purpose of this study was to discern the effects of music therapy on the patients' level of anxiety and operative satisfaction during cataract surgery under local anesthesia. Method: The subjects for this study were fifty patients. Half of the subjects were categorized as an experimental group and the other half as a control group. All of the subjects were admitted to one hospital in Seoul for cataract surgery. This study was conducted from September 7 to October 2, 2002. The level of anxiety determined by self-reporting anxiety, pulse rate, systolic blood pressure, and diastolic blood pressure, was measured before and after the music therapy. The satisfaction degree was measured after the surgery. The tools for this study were Spilberger's state anxiety inventory and Patient Care Management System. Each patient in the experimental group chose the music used in his/her surgery and it was played through an audio system in the operating room. The data analysis was performed using the SAS/pc+(version 8.0). Results: 1. The anxiety of the experimental group decreased significantly compared to the control group. 2. The pulse rate of the experimental group decreased more than the control group. 3. The blood pressure of the experimental group decreased more than the control group. 4. The operative satisfaction of the experimental group was higher than the control group. Conclusion: According to the previous results, music therapy turned out to be a very efficient way to increase the satisfaction of a cataract patient after surgery by reducing the anxiety and the pulse rate of the patient during an operation with local anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.345-355
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• 2021

Background: This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration. Methods: This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4-11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy^® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05. Results: Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group. Conclusion: External vibration using a Buzzy^® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.