• Restorative Dentistry and Endodontics
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• v.46 no.3
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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 Periodontal and Implant Science
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• v.42 no.2
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• pp.45-49
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• 2012

Purpose: The aim of the present clinical trial was to compare pain during injection of anterior middle superior alveolar (AMSA) technique with that of infiltration injection technique in the maxilla in periodontal flap surgeries of patients referring to the Department of Periodontics, Faculty of Dentistry, Tabriz University of Medical Sciences. Methods: Twenty subjects with an age range of 20 to 40 years were selected for the present study. One side of the maxilla was randomly selected as the test side and the other as the control side using a flip of a coin. AMSA technique was used on the test side and infiltration technique was used on the control side for anesthesia. On both sides 2% lidocaine containing 1:80,000 epinephrine was used for anesthesia. The operator obtained the visual analogue scale for each patient immediately after the injection and immediately after surgery. Data was analyzed using descriptive statistical methods (frequency percentages, means and standard deviations) and Wilcoxon's test using SPSS ver. 13 (SPSS Inc.). Statistical significance was defined at P<0.05. Results: There were no statistically significant differences in pain during injection between the two techniques (P=0.856). There were statistically significant differences in postoperative pain between the two injection techniques (P=0.024). Conclusions: Postoperative pain in AMSA injection technique was less than that in the infiltration technique. Therefore, the AMSA technique is preferable in the periodontal surgeries for the anesthesia of palatal tissues given the fact that it has other advantages, too.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.159-163
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• 2008

Paraplegia is a relatively rare complication of epidural anesthesia. Several possible factors may contribute to the development of paraplegia including arachnoiditis, trauma and ischemia. We experienced a case where paraplegia had developed after epidural anesthesia for cesarean section. So we present the case and consider the possible etiologies. A 30-year-old previously healthy woman was referred to our hospital for postpartum motor weakness of the lower limbs. Six days prior, the patient was admitted at a local obstetric clinic for delivery at 39 weeks gestation. The patient underwent a Cesarean section under epidural anesthesia induced with 20 ml 2% lidocaine and 5 ml 0.5% bupivacaine. In the early morning of the day following the Cesarean section, a motor and sensory deficit in both lower extremities was noted. A lumbar MRI showed diffuse enhancement along the cauda equina and spinal cord surface in the lower lumbar spine, suggesting diffuse arachnoiditis.

• The Korean Journal of Pain
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• v.32 no.4
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• pp.286-291
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• 2019

Background: Breast cancer is complicated by a high incidence of chronic postoperative pain (25%-60%). Regional anesthesia might play an important role in lowering the incidence of chronic pain; however it is not known if the pectoral nerve block (PECS block), which is commonly used for breast surgery, is able to prevent this complication. Our main objective was therefore to detect any association between the PECS block and chronic pain at 3, 6, 9, and 12 months in patients undergoing breast surgery. Methods: We conducted a prospective, monocentric, observational study. We enrolled 140 consecutive patients undergoing breast surgery and divided them in patients receiving a PECS block and general anesthesia (PECS group) and patients receiving only general anesthesia (GA group). Then we considered both intraoperative variables (intravenous opioids administration), postoperative data (pain suffered by the patients during the first 24 postoperative hours and the need for additional analgesic administration) and development and persistence of chronic pain (at 3, 6, 9, and 12 mo). Results: The PECS group had a lower incidence of chronic pain at 3 months (14.9% vs. 31.8%, P = 0.039), needed less intraoperative opioids (fentanyl $1.61{\mu}g/kg/hr$ vs. $3.3{\mu}g/kg/hr$, P < 0.001) and had less postoperative pain (3 vs. 4, P = 0.017). Conclusions: The PECS block might play an important role in lowering incidence of chronic pain, but further studies are needed.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.14 no.2
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• pp.102-105
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• 2018

Hemophilia is an X-linked herediatry disorder. Hemophilia A is a defiency of factor VIII and hemophilia B (Christmas disease) is a deficiency of factor IX. The most widely used classification is based on plasma procoagulant levels, with people <1% factor defined as severe; 1 - 5% moderately severe; and >5% as mild. A 7 years old boy visited our clinic with chief complaint of impacted supernumerary tooth. This boy had severe hemophilia A. With the previous $ADVATE^{(R)}$ injection and factor VIII replacement, Extraction of supernumerary tooth was successfully done under General anesthesia. A 9 years old boy referred from local clinic for dental caries treatment. This boy had severe hemophilia B. With the preparation of $BeneFIX^{(R)}$ injection, dental treatment was done successfully under general anesthesia. It is often first detected by dental trauma. Since bleeding after dental treatment may cause severe or even fatal complications, people with hemophilia must be given special dental care. The treatment of the patients with either hemophilia A or hemophilia B involves the intravenous infusion to either control or prevent bleeding.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.239-254
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• 2022

The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.

• Journal of Oral Medicine and Pain
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• v.32 no.2
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• pp.177-185
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• 2007

Iatrogenic injury following dental treatments and the use of local anesthetics may cause taste disorders. The aims of this study were to investigate quantitative and qualitative changes of taste due to unilateral inferior alveolar nerve block anesthesia and further to evaluate potential effects on taste function related to anesthesia or hypoesthesia of inferior alveolar nerve, possibly occurring after dental procedure. 30 healthy volunteers in their twenties participated in this study (male to female = 1:1, mean age of $24.0{\pm}1.8$ years). Each subject received inferior alveolar nerve block anesthesia on his or her right side with 2% lidocaine HCl containing 1:100,000 epinephrine. Before and after anesthesia, electrogustometric test and chemical localized test for salty, sweet, sour and bitter tastes were performed on the eight sites in the oral cavity; right and left anterior and lateral tongue and circumvallate papilla of the tongue and soft palate. Unilateral inferior alveolar nerve anesthesia produced elevation of electrical taste threshold and reduction of intensity ratings for all 4 tastes (salty, sweet, sour and bitter) over anterior and lateral tongue and circumvallate papilla on the ipsilateral side (p<0.05). Contralateral sides exhibited decreased intensity ratings for salty and sweet taste (p<0.05) on anterior and lateral tongue while there was no significant difference in electrogustometric testing. Based on the results of this study, it is assumed that unilateral local anesthesia on inferior alveolar nerve can affect chorda tympani and glossopharyngeal nerves on the same side, leading to taste deficits. Taste intensity on the contralateral side may, in part, be deteriorated as well.

• Restorative Dentistry and Endodontics
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• v.31 no.4
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• pp.257-262
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• 2006

The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats under general anesthesia before and after injection of local anesthetics and after cavity preparation. 2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into the dentin on both teeth. The obtained data was analyzed with paired t-test. Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05), whereas there was no significant change of PBF with the physiologic saline as a control. Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less increase of PBF than in control tooth (p < 0.05). Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with 1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1976.06a
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• pp.87.4-88
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• 1976

The statistcal study was done on 81 cases of the foreign bodies in the food passages (73 cases) and air passages (8 cases), who had visited the Dept. of Otolaryngology of Kyung Hee Medical Center and treated endoscopically, from Nov. 1971 to Mar 1976. The results were as follows, 1) The incidence of esophageal foreign bodies (73 cases) in order of frequency was coin (61 cases; 83.6%), bone (6 cases; 8.2%), food particles (3 cases; 4.1%), discs (2 cases), and other metals (l case). The incidence of foreign bodies in the air passages (8 cases) was food particles (3 cases; 37.5%), pointed metal (2 cases; 25%), plastic pencil cap (l case), plastic ring (1 case), and wood piece (1 case) in order. 2) In sex distribution, 51 cases (62.9%) were males and 30 cases (37.1%) were females, and the ratio between males and females was about 1.7 : 1.3. In the age incidence, 69 cases (82.5%) of all foreign bodies were under 5 years of age, and especially, coin cases were 59 cases (96.7%) and the highest was 8 years of age, lowest was 11 months of age. 7 cases (87.5%) of all airway foreign bodies were under 10 years of age. 4) The ratio between the food passages(73 cases) and the air passages (8 cases) was about 9 : 1. In the location of the foreign bodies of the food passages, 66 cases (90.4%) were in the first esophageal narrowing, 5 cases (6.9%) in the second narrowing, and 2 cases (2.7%) in the third narrowing. In the air passages, the frequent sites were trachea (5 cases; 62.5%), larynx (2 cases), and bronchus (1 case) in order. 5) In duration of lodgement, 63 cases (86. 3%) of esophageal foreign bodies were removed within 24 hours, and one case was removed within 16 days. The number of cases lodged within 24 hours were 4 cases (50%). in the air passages and one case was removed within 18 days. 6) In treatment, 37 cases (50.7%) of esophageal foreign bodies were extracted by modified upper esophagoscopy, 33 cases (42.5%) by esophagoscopy under the local anesthesia, 3 cases (4.1%) by esophagoscopy under the general anesthesia. 8 cases of the coin cases were passed into the stomach during the endoscopic examination. Laryngeal foreign bodies (2 cases; 25%) were extracted by laryngoscopy under the local anesthesia. 2 cases (40%) of tracheal foreign bodies by Bronchoscopy with tracheotomy under the local anesthesia, 3 cases (60%) by Bronchoscopy under the general anesthesia, and bronchial foreign body (1 case) by open thoracotomy under the general anesthesia, at the Dept. of Chest surgery.

• Journal of Korean Physical Therapy Science
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• v.8 no.2
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• pp.1005-1013
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• 2001

The present study was designed to investigate the effect of low power GaAlAs laser on spinal Fos expression related to the anti-nociceptive effect of laser stimulation. Low power GaAlAs laser was applied to either acupoint or non-acupoint for 2 hour under light inhalation anesthesia. Spinal Fos expression in the dorsal horn was compared to that obtained in inhalation anesthesia control group. Furthermore, we analyzed the effect of the local treatment of lidocaine on the spinal Fos expression evoked by low power GaAlAs laser stimulation. The results were summarized as follows: 1. In the normal animals, only a few Fos like immunoreactive(Fos-IR) neurons were evident in the lumbar spinal cord dorsal horn. Similarly, following prolonged inhalation anesthesia, Fos-IR neurons were absent in the dorsal horn of the lumbar spinal cord. In animals treated with laser stimulation, Fos immunoreactive neurons were increased mainly in the medial half of ipsilateral laminae I-III at lumbar segments L3-5. These findings directly indicated that prolonged anesthesia used in this study did not affect the Fos expression in the spinal cord dorsal horn of intact animals and low power laser stimulation dramatically produced Fos expression in the spinal cord laminae that are related to the anti-nociceptive effect of laser stimulation. 2. In acupoint stimulated animals, 10mW of laser stimulation, not 3mW and 6mW intensity, significantly increased the number of Fos immunoreactive neurons in the spinal dorsal horn(p<0.05). However, laser stimulation on acupoint more dramatically increased the number of Fos immunoreactive neurons in the spinal cord rather than laser stimulatin on non acupoint. These result suggested that laser stimulatin on acupoint was more effective treatment to activate the spinal neuron than non acupoint stimulation. 3. The local treatment of lidocaine totally suppressed the activity of spinal neurons that were induced by lower power 1aser stimulation. These data indicated that the anti-nociceptive effect of laser stimulation was absolutely dependent upon the peripheral nerve activity in the stimulated location. In conclusion, these data indicate that 10mW of low power laser stimulation into acupoint is capable of inducing the spinal Fos expression in the dorsal horn related to the anti-nociceptive effect of laser stimulation, Furthermore, the induction of spinal Fos expression was totally related to the peripheral nerve activity in the laser stimulated area.