• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.161-168
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• 2017

Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, single-injection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권2호
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• pp.55-61
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• 2020

During dental treatment, a dentist usually applies the local anesthesia. Therefore, all dentists should have expertise in local anesthesia and anesthetics. Local anesthetics have a neurotoxic effect at clinically relevant concentrations. Many studies have investigated the mechanism of neurotoxicity of local anesthetics but the precise mechanism of local anesthetic-induced neurotoxicity is still unclear. In addition, it is difficult to demonstrate the direct neurotoxic effect of local anesthetics because perioperative nerve damage is influenced by various factors, such as the anesthetic, the patient, and surgical risk factors. This review summarizes knowledge about the pharmacology of local anesthetics, nerve anatomy, and the incidence, risk factors, and possible cellular mechanisms of local anesthetic-induced neurotoxicity.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권2호
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• pp.63-72
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• 2020

Dental local anesthesia is performed daily on a global scale. Adverse effects are rare, but the topic of neurotoxicity of local anesthetics deserves to be explored, as publications can be controversial and confusing. Therefore, a need was felt to address and question the evidence for potential neurotoxicity of dental local anesthetics. This review aimed to assess the studies published on the neurotoxicity of dental local anesthetics. A Pubmed^Ⓡ search was conducted between January 2019 and August 2019. This revealed 2802 hits on the topic of neurotoxicity or cytotoxicity of the following anesthetics: lidocaine, prilocaine, mepivacaine, articaine, ropivacaine, and bupivacaine. Only 23 papers were deemed eligible for this review: 17 in vitro studies, 3 reviews and 3 audits of national inquiries. The heterogeneous literature on this topic showed that all dental local anesthetics are potentially neurotoxic in a concentration and/or exposure time fashion. There seems no consensus about what cell lines are to be used to investigate the neurotoxicity of local anesthetics, which makes the comparison between studies difficult and ambiguous. However, the bottom line is that all dental local anesthetics have a neurotoxic potential, but that there is no unanimity in the publications about which local anesthetic is the least or the most neurotoxic.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.81-90
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• 2017

Pregnancy induces significant anatomical and physiological changes in the mother. Many pregnant women need dental treatment due to poor oral hygiene related to pregnancy. However, most dentists are reluctant to provide, and most pregnant women are reluctant to receive, dental treatment during pregnancy. Theoretically, maternally administered drugs are transferred to the fetus. Depending on the types of drugs and the stage of pregnancy, the effects of drugs on the mother, as well as the fetus, may vary. Local anesthetics are the most widely used in dental treatment. It is, therefore, important to understand the potential effects of local anesthetics during pregnancy. In this review, we will focus on the maternal and fetal effects of local anesthetics widely used in dental treatment with consideration of the use of local anesthetics during pregnancy.

• International Journal of Oral Biology
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• 제32권2호
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• pp.45-49
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• 2007

In this study, the cytotoxicity of commonly used local anesthetics was evaluated on odontoblasts which are essential for pulpal homeostasis in vitro. Local anesthetics, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and procaine, were tested on the odontoblast cell line, MDPC-23. The concentration-and time-dependent cytotoxic effects of local anesthetics on odontoblasts were measured by MTT assay. Among local anesthetics treated for 18 h, only bupivacaine significantly showed cell death in a concentration-($LC_{50}=1.2mM$) and time-dependent manner. To confirm cell death induced by bupivacaine, the observation of cell morphology and FACS using Annexin V and propidium iodide (PI) staining were performed. As a result of Annexin V and PI staining, as well as the morphological change, only bupivacaine induced apoptotic cell death on odontoblasts when compared with levobupivacaine and lidocaine. These results suggest that bupivacaine might affect normal pulpal integrity even after uneventful local anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권6호
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• pp.319-332
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• 2018

The objective of this review was to investigate the efficacy of dental local anesthetics, as it is well known among clinicians that local anesthesia may be challenging in some circumstances. Therefore, the focus of this review was on the efficacy of the products used in dental local anesthesia. In a Pubmed database literature search conducted, a total of 8646 articles were found to be related to dental local anesthetics. After having applied the inclusion criteria (human research, performed in the last 10 years, written in English language, and focus on dental local anesthetics) and having assessed the quality of the papers, 30 were deemed eligible for inclusion in this review. The conclusion of this review is that none of the dental local anesthetic amides provide 100% anesthesia. The problem appears to be more pronounced when mandibular teeth are attempted to be anaesthetized and especially if there is irreversible pulpitis involved. The authors conclude that this finding suggest exploration of more efficient techniques to administer dental local anesthesia, especially in the mandible, to establish a 100% efficacy, is needed.

• 생명과학회지
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• 제2권2호
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• pp.97-107
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• 1992

비록 국소마취제가 신경세포막 당단백질중의 하나인 sodium channel과의 직접적인 상호작용에 의하여 그 특유의 국소마취제를 나타낸다고 할지라도 신경세포막의 골격을 형성하고 있는 지질과 국소마취제와의 상호작용을 분자적 국소마취제 작용기전을 설명함에 있어 배제할 수는 없다. 왜냐하면 sodium channel은 지질과의 공유 또는 비공유결합을 통해 단단하게 결합되어 있기 때문이다. 따라서 국소마취제가 직접 sodium channel과 결합, 상호작용하여 Na+의 유입을 차단할 뿐만 아니라 직접 지질의 측방 및 회전확산 운동을 증가시킴으로써 간접적으로 sodium channel의 conformational change가 유발되어 Na+의 유입이 차단되는 등의 복합적인 기전에 의하여 그 특유의 국소마취작용이 나타나는 것이다.

• 대한약리학회지
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• 제23권2호
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• pp.113-121
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• 1987

국소마취제가 mitochondria에서의 전자이동 및 superoxide라디칼의 생성 그리고 지질의 과산화에 따른 malondialdehyde생성에 미치는 영향을 관찰하였다. 국소마취제는 전자이동계 의 효소활성도에 영향을 나타내었다. NADH dehydrogenase, NADH oxidase와 NADH-ubiquinone oxidoreductase의 활성도는 lidocaine, procaine과 dibucaine에 의하여 효과적으로 억제되었고 cocaine에 의하여 약간 억제되었다. Succinate dehydrogenase, succinate cytochrome c oxidoreductase와 succinate-ubiquinone oxidoreductase 활성도는 lidocaine 과 dibucaine에 의하여 억제되었으나 succinate oxidase는 국소마취제에 의하여 활성화되었다. 국소마취제는 dihydroubiquinone-cytochrome c oxidoreducatse와 cytochrome c oxidase의 활성도를 억제하였다. 이와 같은 반응에서 국소마취제에 대한 complex I segment의 반응이 다른 complex segment보다 크게 나타났다. 국소마취제는 succinate 또는 NADH에 의한 superoxide 생성과 이에 대한 antimycin의 자극효과를 억제하였다. 또한 국소마취제는 산소라디칼에 의한 지질의 과산화를 억제하였다. 이상의 결과로부터 국소마취제는 mitochondria의 전자전달 과정 중 Complex I segment때 또는 인접한 부위에 작용하여 전자이동을 억제함으로써 superoxide 생성과 지질의 과산화를 억제할 것으로 시사되었다.

• 대한소아치과학회지
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• 제44권3호
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• pp.365-369
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• 2017

국소마취제는 치과 영역에서 임상적으로 널리 사용되어 왔으나, 국소마취제로 인한 과민반응은 매우 드물게 나타난다. 그러나 낮은 발생률에도 불구하고, 국소마취제로 인한 과민반응 증례가 보고되어 왔다. 본 증례는 충차치료를 주소로 내원한 26개월 남환에서 관찰된 과민반응으로, 리도카인 국소마취 후 하순의 부종이 발생하였다. 항히스타민제와 스테로이드의 사용으로 증상이 경감되었다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권4호
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• pp.237-244
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• 2016

Topical anesthetics act on the peripheral nerves and reduce the sensation of pain at the site of application. In dentistry, they are used to control local pain caused by needling, placement of orthodontic bands, the vomiting reflex, oral mucositis, and rubber-dam clamp placement. Traditional topical anesthetics contain lidocaine or benzocaine as active ingredients and are used in the form of solutions, creams, gels, and sprays. Eutectic mixtures of local anesthesia cream, a mixture of various topical anesthetics, has been reported to be more potent than other anesthetics. Recently, new products with modified ingredients and application methods have been introduced into the market. These products may be used for mild pain during periodontal treatment, such as scaling. Dentists should be aware that topical anesthetics, although rare, might induce allergic reactions or side effects as a result of an overdose. Topical anesthetics are useful aids during dental treatment, as they reduce dental phobia, especially in children, by mitigating discomfort and pain.