• Restorative Dentistry and Endodontics
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• 제46권3호
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• pp.41.1-41.23
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• 2021

Objectives: This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. Materials and Methods: Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. Results: The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. Conclusions: Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권6호
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• pp.293-302
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• 2023

This review paper delves into the comparative study of epinephrine and phenylephrine as vasoconstrictors in dental anesthesia, exploring their histories, pharmacological properties, and clinical applications. The study involved a comprehensive literature search, focusing on articles that directly compared the two agents in terms of efficacy, safety, and prevalence in dental anesthesia. Epinephrine, with its broad receptor profile, has been a predominant choice, slightly outperforming in the context of prolonging dental anesthesia and providing superior hemostasis, which is crucial for various dental procedures. However, the stimulation of beta-adrenergic receptors caused by epinephrine poses risks, especially to patients with cardiovascular conditions. Phenylephrine, a selective alpha-1 adrenergic agonist, emerges as a safer alternative for such patients, avoiding the cardiovascular risks associated with epinephrine. Moreover, its vasoconstrictive effect may not be as deleterious as that of epinephrine, due to its selective action. This review reveals that despite the potential benefits of phenylephrine, epinephrine continues to dominate in clinical settings, due to its historical familiarity, availability, and cost-effectiveness. The lack of commercially available pre-made phenylephrine dental carpules in most countries, except Brazil, and a knowledge gap within dental academia regarding phenylephrine, contribute to its limited use. This review concludes that while both agents are effective, the choice between them should be based on individual patient conditions, availability, and the practitioner's knowledge and familiarity with the agents. The underuse of other vasoconstrictors like levonordefrin and the unavailability of phenylephrine in pre-mixed dental cartridges in many countries highlights the need for further exploration and research in this field. Furthermore, we also delve into the role of levonordefrin and examine the rationale behind the exclusion of phenylephrine from commercially available pre-mixed local anesthetic carpules, suggesting a need for a responsive approach from pharmaceutical manufacturers to the distinct needs of the dental community.

• 대한수의학회지
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• 제63권3호
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• pp.21.1-21.6
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• 2023

The increasing prevalence of toxic substance-exposure in pets in South Korea endangers the health and safety of numerous companion animals, and has become a cause for concern. Notably, the annual incidence of forensic analysis in pets has increased by more than 150% in South Korea, mainly in populous regions such as Seoul, Incheon, and Gyeonggi. In response to this growing issue, veterinary forensic examinations were conducted on 549 dogs and cats from 2019 to 2022. This study revealed the presence of various toxic substances, including pesticides, insecticides, and drugs such as analgesics, anesthetics, antidepressants, and muscle relaxants, in pets. Among the 38 different toxins identified in pets, coumatetralyl, methomyl, terbufos, and buprofezin were the most frequently detected. In this study, toxic substances for pets were identified based on the "toxic agent list for humans," developed by the National Forensic Services, because no list of toxic agents for animals currently exists and data regarding potentially toxic substances for dogs and cats is limited. This is one of the limitations of this study, and necessitates the establishment of a toxic agent list for animals. Continued monitoring and research is also recommended to reveal the incidence, causes, and solutions of toxicity in animals.

• 대한두개안면성형외과학회지
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• 제25권1호
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• pp.17-21
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• 2024

Background: The pain caused by local anesthetic injection can lead to patient anxiety prior to surgery, potentially necessitating sedation or general anesthesia during the excision procedure. In this study, we aim to compare the pain relief efficacy and safety of using a digital automatic anesthetic injector for local anesthesia. Methods: Thirty-three patients undergoing excision of a benign soft tissue tumor under local anesthesia were prospectively enrolled from September 2021 to February 2022. A single-blind, randomized controlled study was conducted. Patients were divided into two groups by randomization: the experimental group with digital automatic anesthetic injector method (I-JECT group) and the control group with conventional injection method. Before surgery, the Amsterdam preoperative anxiety information scale was used to measure the patients' anxiety. After local anesthetic was administered, the Numeric Pain Rating Scale was used to measure the pain. The amount of anesthetic used was divided by the surface area of the lesion was recorded. Results: Seventeen were assigned to the conventional group and 16 to the I-JECT group. The mean Numeric Pain Rating Scale was 1.75 in the I-JECT group and 3.82 in conventional group. The injection pain was lower in the I-JECT group (p< 0.01). The mean Amsterdam preoperative anxiety information scale was 11.00 in the I-JECT group and 9.65 in conventional group. Patient's anxiety did not correlate to injection pain regardless of the method of injection (p= 0.47). The amount of local anesthetic used per 1 cm² of tumor surface area was 0.74 mL/cm² in the I-JECT group and 2.31 mL/cm² in the conventional group. The normalization amount of local anesthetic was less in the I-JECT group (p< 0.01). There was no difference in the incidence of complications. Conclusion: The use of a digital automatic anesthetic injector has shown to reduce pain and the amount of local anesthetics without complication.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권3호
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• pp.161-171
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• 2024

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권2호
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• pp.91-99
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• 2024

Background: Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. Methods: A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. Results: The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Conclusion: Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

• 한국안광학회지
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• 제17권2호
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• pp.215-222
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• 2012

목적: 본 연구는 콘택트렌즈 착용 여부와 사무실 실내공기질이 안구건조에 미치는 영향이 있는지 파악하고자 하였다. 방법: 71명의 연구 대상자들의 각 사무실에서 실내공기질이 안구건조에 미치는 영향을 파악하기 위하여 이산화탄소($CO_2$), 온도(temperature), 습도(relative humidity), 총 부유분진(TSP), 미세먼지($PM_{10}$), 포름알데히드(HCHO)를 측정분석 하였고, 안구 건조증을 확인하기 위하여 연구 대상자들의 사무실에서 McMonnies dry eye symptom questionnaire, Schirmer Tear Test-I(S.T.T-I), Schirmer Tear Test-II with anesthetics(S.T.T-II), Tear film break-up time(T.B.U.T) 등을 검사 하였다. 결과: 콘택트렌즈 착용여부에 따라 사무실 실내공기질이 안구건조증에 영향을 미치는 요인으로는 TSP는 $200{\mu}g/m^3$, $PM_{10}$은 $86.7{\mu}g/m^3$, 포름알데히드는 $0.4{\sim}1.0{\mu}g/m^3$을 기준으로 농도가 높게 측정되었을 때 유의한 관련성이 있는 것으로 분석되었다. 그러나 $CO_2$(p=0.146), 온도(p=0.074)와 습도(p=0.053)는 통계적으로 안구건조와 유의한 관련성이 없는 것으로 분석되었다. 결론: 사무실 재실자의 안구 건조에 $CO_2$ 및 온도, 습도는 유의한 영향이 없었으나, TSP, $PM_{10}$, 포름알데히드의 실내 농도와 콘택트렌즈의 착용여부는 관련이 있었다. 콘택트렌즈 착용에 대한 종합적인 관리와 사무실 실내공기의 개별적인 평가가 함께 이루어져야 하겠다.

• Journal of Yeungnam Medical Science
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• 제11권2호
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• pp.270-276
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• 1994

최근 소아과 영역에서 통증 완화를 위해 사용되기 시작한 통증 완화용 연고 제재인 EMLA를 영아의 예방 접종시에 사용함으로써 영아의 통증 완화 효과를 알아 보기 위해 영남대학교 의과대학 부속병원 육아 상담실에서 DPT 예방 접종을 시행한 2개월에서 8개월 사이의 영아 80명을 대상으로 하여 통증 완화용 연고제를 사용한 40례(남아 25례, 여아 15례)와 사용하지 않은 40례(남아 21례, 여아 19례)로 나누어 비교 관찰하였다. 통증에 대한 반응을 McGrath's face scale과 Oucher pain scale, MBPS로 비교 관찰하였으며, 접종후 울음 시작 시간, 첫 울음 지속 시간, 총 울음지속 시간 등을 비교하여 다음과 같은 결과를 얻었다. 1) 대상 환아의 성별이나 연령의 분포상의 차이가 보이지 않았다.(EMLA 사용군의 평균 연령 : $4.0{\pm}0.2$개월, 대조군 : $4.5{\pm}0.8$개월) 2) 통증의 정도는 McGrath's face scale(p<0.05), Oucher pain scale(p<0.05), MBPS(p<0.01)을 이용하여 측정한 결과 EMLA 사용군에서 대조군에 비해 유의한 통증의 감소를 볼 수 있었다. 3) 주사후 첫 울음 시작 시간의 경우 EMLA 사용군에서도 $2.1{\pm}1.3$초, 대조군에서도 $2.0{\pm}0.9$초를 보여 차이가 없었으나, 평균 첫 울음 지속 시간의 경우 EMLA 사용군에서는 $6.9{\pm}4.0$초 대조군에서는 $14.2{\pm}9.2$초를 보여 현저한 감소를 보였다.(p<0.05) 평균 총 울음 지속시간의 경우도 EMLA 사용군에서 $9.8{\pm}6.0$초, 대조군에서 $21.9{\pm}12.8$초로 EMLA 사용군에서 현저한 울음 시간의 감소를 보였다.(p<0.05) 4) 부작용으로는 일시적 발작이 5례에서만 관찰되었다. 국소마취 연고를 영아에 대한 예방접종시에 사용함으로써 부작용 없이 통증이 완화되는 것을 관찰하였다. 그러나 EMLA 연고로 통증이 완화될 뿐 완전히 없어지는 것이 아니고, 연고 제재의 효과발현을 위하여 1시간 동안 부착하여야 하는 불편과 연고의 비용이 고가인 점 등의 문제점이 있어 예방접종시에 일상적으로 사용하기에는 아직 현실적으로 부적당하다고 생각되었다.

• 대한소아치과학회지
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• 제43권1호
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• pp.17-26
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• 2016

러버댐 방습은 환자와 술자를 보호하고 양질의 치료 결과를 얻기 위해 소아, 청소년 환자 치료 시 매우 유용하게 사용되고 있는 술식으로 다양한 장점을 가지고 있으나, 일부 환자들은 이에 불편감을 호소하기도 한다. 본 연구는 러버댐 방습에 대한 환자 및 보호자들의 선호도와 그에 미칠 수 있는 요인들에 대해 알아보기 위하여 계획되었다. 비진정치료 하에 ${\bigcirc}{\bigcirc}$대학교 치과병원 소아치과, 보존과, 일차외래에 내원하여 러버댐을 착용하에 치료를 받은 4-18세 환자들을 대상으로 작성된 설문지를 전자 차트 기록을 통하여 취합하였다. 환아들은 러버댐 방습에 대해 긍정적으로 생각하는 경향을 보였고, 치과 치료에 대해 긍정적으로 생각하는 그룹이 러버댐 방습에 대해서도 더 긍정적으로 생각하는 것으로 나타났다. 치료 시간이 짧은 그룹, 러버댐 방습에 대한 지식 및 경험이 있는 그룹에서 러버댐 방습에 대한 태도가 더 긍정적인 것으로 나타났으며(p < 0.05), 성별, 나이, 치료 내용, 마취 여부, 치료 부위, 술자 요인에 대해서는 유의한 차이가 관찰되지 않았다(p > 0.05).

• The Korean Journal of Pain
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• 제33권4호
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.