• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.16-21
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• 2011

Background: Since introduced by Gow-Gates GA in 1973, Gow-Gates mandibular nerve block (GMNB) has played an important role in the area of dental local anesthesia. However, compared to the conventional inferior alveolar nerve block (IANB), this technique seems to fail to attract the attentions of general practitioners in South Korea. The aim of this study was to prove the clinical real value, mainly the anesthetic efficacy, of GMNB in minor oral surgery. Methods: The study group comprised 40 patients (15 males and 25 females) who were randomly allocated to receive GMNB or IANB for extraction of third molars. Both techniques utilized two 1.8 ml dental cartridges of 2% lidocaine including 1:100,000 epinephrine for each patient. Pulpal and gingival tissue anesthesia of mandibular premolars and molars were recorded at 0, 15 and 40 minutes after administration of local anesthetics using both an electric pulp tester and a sharp dental explorer. Results: The success rates of pulpal and gingival tissue anesthesia in the IANB group were not significantly different from the GMNB group in overall efficacy. Patient's and operator's satisfaction ratings were also not significantly different between two groups. Interestingly, the injection pain of GMNB group was significantly lower than that of IANB group. Conclusion: This study demonstrated that the anesthetic efficacy of pulpal and gingival tissue of GMNB was not inferior to that of IANB. The GMNB could be a good alternative of the IANB in most of minor oral surgical procedures.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.1
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• pp.45-54
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• 2019

Background: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. Methods: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. Results: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. Conclusions: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.147-154
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• 2020

Background: Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO₄), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO₄ in patients with symptomatic irreversible pulpitis and apical periodontitis. Methods: Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO₄ (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker-Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. Results: Administration of 150 mg MgSO₄ hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. Conclusion: Combining 75 mg or 150 mg of MgSO₄ with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO₄ is adequate for endodontic procedures.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.331-341
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• 2022

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.5
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• pp.295-300
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• 2019

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.124-128
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• 2014

Background: A closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful. Methods: We compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia. Results: The diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope. Conclusion: Needle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.1-9
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• 2008

Common dental procedures (local anesthesia and dental treatment) are potentially stress-inducing in many patients, especially medically compromised patients. The body response to dental stress involves the cardiovascular system (an increase in cardiovascular workload), the respiratory organ and the endocrine system (change in metabolism). To minimize the stress to the medical risk patient, the stress reduction protocol was established. The obtained contents were as follows: (1) Recognize the patient's degree of medical risk (2) Complete medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative, perioperative and postoperative vital signs (5) Use psychosedation during therapy (6) Use adequate pain control during therapy (7) Short length of appointment: do not exceed the patient's limits of tolerance (8) Follow up with postoperative pain/anxiety control (9) Telephone the higher medical risk patient later on the same day that treatment was given. This protocol is predicated on the belief that the prevention of or reduction of stress ought to begin before the start of an appointment, continue throughout treatment, and, if indicated, into the postoperative period. The authors used the stress reduction protocol in the care of local anesthesia infected teeth in medically compromised patients. The final prognosis was comfortable without any complications.

• Archives of Craniofacial Surgery
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• v.16 no.3
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• pp.151-153
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• 2015

Closed reduction is the treatment of choice for most nasal bone fractures. In this technique, the nasal bone cannot be directly visualized, proper reduction is confirmed by palpation of the bony contour. This confirmation-via-palpation is in most cases too uncomfortable or painful for patients, and this is the reason why most closed reductions of nasal bone fractures are performed under general anesthesia. Recently, ultrasonography has been adopted as a useful diagnostic method and operative adjunct. In this report, we report the use of ultrasonography as a means to provide palpation-less confirmation of proper reduction, which in turn allows for nasal bone reduction under local anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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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.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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• pp.97-100
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• 2015

One complication related to local anesthesia in the dental clinic is a broken needle. Although rare, a broken needle may be difficult to retrieve. Dental radiographs and 3D CT have been used in the past to confirm the location of a broken needle. We present the case of a broken needle, which was successfully removed using a careful, microscopic approach.