• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.49-59
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• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).

• The Korean Journal of Pain
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• 제13권1호
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• pp.44-48
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• 2000

Background: The continuous epidural analgesia is a popular method in the management of postoperative pain. However, the exact regimen for the optimal analgesia is still in dispute. In this study, we evaluated the effect of an initial loading dose prior to the continuous epidural infusion after a brief surgery, which may have some residual effects of local anesthetics that is used for the intraoperative epidural anesthesia. Methods: Seventy five patients required epidural anesthesia with 15 ml of 2% mepivacaine for the perianal surgery were randomly divided into three groups: Group 1, being the control group (n=25) did not received postoperative epidural pain control. But, group 2 (n=25) and 3 (n=25) received continuous epidural analgesia with local anesthetics and morphine immediately after surgery. In Group 2, the patients received continuous epidural infusion without initial loading dose. In Group 3, the patients received initial loading dose (1% mepivacaine 6 ml and morphine 1 mg) and followed by continuous epidural infusion. We evaluated the number of patients who needed adjuvant analgesics, the pain score, and incidence of side effects for the postoperative 48 hours. Results: At postoperative 12 hours, in group 3, the two variables, the number of patients who needed analgesics and the pain score showed a statistical significance with low scores compared with group 1 and 2. At postoperative 24 and 48 hours, the two variables indicated above did not show any differences in group 2 and 3. The incidence of side effects is not different among the three groups. Conclusions: The loading dose prior to continuous epidural infusion is necessary after a brief surgery which may have some residual effects of local anesthetics that is used for the intraoperative epidural anesthesia.

• Archives of Plastic Surgery
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• 제42권1호
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• pp.28-33
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• 2015

Background Topical anesthetics, such as eutectic mixture of local anesthetics (EMLA) cream, can be applied to reduce pain before minor procedure. This trial evaluated EMLA as pretreatment for facial lacerations and compared pain, discomfort and overall satisfaction. Methods This trial included consecutive emergency department patients ${\geq}16years$ of age who presented with simple facial lacerations. At triage, lacerations were allotted to either the routine processing group or EMLA pretreatment group according to date of admission. Initially, the emergency department doctors inspected each laceration, which were dressed with saline-soaked gauze. In the pretreatment group, EMLA cream was applied during wound inspection. The plastic surgeon then completed primary closure following the local injection of an anesthetic. After the procedure, all patients were given a questionnaire assessing pain using the 10-point visual analog scale (VAS) ("no pain" to "worst pain"). All questionnaires were collected by the emergency department nurse before discharge. Results Fifty patients were included in the routine processing group, and fifty patients were included in the EMLA pretreatment group. Median age was 39.9 years, 66% were male, and the average laceration was 2.67 cm in length. The EMLA pretreatment group reported lower pain scores in comparison with the routine processing group (2.4 vs. 4.5 on VAS, P<0.05), and lower discomfort scores during the procedure (2.0 vs. 3.3, P=0.60). Overall satisfaction was significantly higher in the EMLA pretreatment group (7.8 vs. 6.1, P<0.05). Conclusions Pretreating facial lacerations with EMLA topical cream aids patients by reducing pain and further enhancing overall satisfaction during laceration treatment.

• The Korean Journal of Pain
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• 제11권2호
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• pp.343-345
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• 1998

Stellate ganglion block and cervical epidural nerve block are frequently practiced in pain clinics because of simple procedure and good effect. Nerve block at head and neck may produce serious complication such as loss of consciousness and cardiac arrest. Blood supply is rich in neck and inadvertent arterial injection of local anesthetics may enter directly into brain. We experienced convulsion and respiratory arrest during SGB and cervical epidural block. The patients were resuscitated successfully and recovered without any adverse effects.

• The Korean Journal of Pain
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• 제6권1호
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• pp.117-121
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• 1993

The pyriformis syndrome is an entrapment neuropathy in which the sciatic nerve is compromised by the pyriformis muscle. Using local anesthetics and steroid injection through a needle guided by an electric nerve stimulator, we satisfactorily treated a case of pyriformis syndrome.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권5호
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• pp.245-256
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• 2023

Background: Surgical and non-surgical periodontal procedures often lead to postoperative pain. Clinicians use pharmacological methods such as anesthetics, anti-inflammatory drugs, and analgesics for relief. However, the multitude of options makes it challenging to select the best approach for routine dental care. Objective: This review aimed to describe previous studies regarding the pharmacological management used for pain control during periodontal procedures as well as factors that may interfere with patients' perception of pain. Methods: We included studies (period of 2000-2023, whose approach corresponded to the pharmacological protocols used for preoperative, trans-operative, and postoperative pain control in adult patients undergoing surgical and non-surgical periodontal therapy. Results: A total of 32 studies were included in the analysis, of which 17 (53%) were related to anesthetic methods and 15 (47%) were related to therapeutic protocols (anti-inflammatory/analgesic agents). These studies predominantly involved nonsurgical periodontal procedures. Studies have reported that factors related to age, type of procedure, and anxiety can influence pain perception; however, only seven of these studies evaluated anxiety. Conclusions: Numerous methods for pain control can be applied in periodontal therapy, which are accomplished through anesthetic methods and/or therapeutic protocols. Factors such as anxiety, age, and type of procedure are related to pain perception in patients. Thus, it is the responsibility of dentists to evaluate each clinical situation and define the best protocol to follow based on the literature.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.41-47
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• 2021

Background: This study was designed to compare the efficacy of DentalVibe against 2% lidocaine gel in reducing pain during the administration of local anesthetic injection in the adult population. Methods: This was a split-mouth open-label, randomized, controlled clinical study conducted in the Department of Oral and Maxillofacial Surgery of a dental institute. Fifty patients who were scheduled for bilateral dental extractions requiring an inferior alveolar nerve block were enrolled in the study. Site A (n = 50) was coated with 2% lidocaine gel followed by a local anesthetic injection, and DentalVibe with local anesthetic injection was used for Site B (n = 50). The primary outcome was pain, which was recorded immediately after the administration of anesthetic injection using the Visual Analogue Scale [VAS 0 - 10]. Results: The VAS pain scores ranged from 4 to 10 for site A and 0 to 6 for site B. Comparison between the two sites showed a statistically significant difference [Mann-Whitney U test value = 51.50, P < 0.001] favoring site B. Conclusion: This study showed that DentalVibe reduces pain during injection of local anesthesia compared to topical anesthetic gel.

• 대한치과의료관리학회지
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• 제9권1호
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• pp.32-37
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• 2021

Many approaches to local anesthesia have been studied in dentistry. In this study, we introduce a new local anesthetic method, "Point-Inject Technique (PIT)", and compare it with traditional injection techniques. The PIT method utilizes both the vasoconstrictive and antinociceptive properties of local anesthetics as well as the application of controlled pressure during injection, reducing the time to complete anesthesia. Fifty patients were selected as the experimental group who were anesthetized using PIT, and the other 50 patients were selected as the control group using the direct injection method with a carpool syringe. The PIT group received 0.25 cartridges of 2% lidocaine with 1:100,000 epinephrine. The control group received 1.5~2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Both groups were asked to mark the intensity of the pain caused by anesthesia using the Numeric Pain Rating Scale. The average time to recover from anesthesia was 40 minutes in the experimental group and 90 minutes in the control group. Additionally, 96% of the experimental group reported feeling no pain, while 78% of the control group reported having some form of pain during injection. The PIT method reduced both the reported pain scores of patients as well as time to recover from local anesthesia than the widely-used syringe injection method.

• The Korean Journal of Pain
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• 제4권2호
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• pp.157-161
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• 1991

경막외강으로 steroid 및 국소마취제투여는 요통치료에 유일한 방법만은 아니나 여러 대증요법중 가장 관심있는 방법중의 하나이다. 비록 요통이나 혹은 방사통이 동반된 경우에서 경막외강으로 steroid를 투여하여 매우 좋은 결과를 얻었다는 보고도 많다. 더우기 급성이며 짧은 병력올 가지고 수술을 받지 않을 경우에는 더욱 극적인 효과를 볼 수 있다. 경막외강으로는 steroid 단독 혹은 생리식염수나 국소마취제를 steroid의 희석제로 동시 사용하는 경우도 있다. 그러므로 steroid때문에 병세가 호전되었는지 혹은 희석제 때문에 호전 되였는지 분간하기 힘든 경우도 있었다. 그러나 투여후 즉각적인 성공적인 결과라 할지라도 지속성(longevity), 실현성(reality) 및 적응(indication)등에 문제가 있는 것은 사실이다.

• The Korean Journal of Pain
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• 제10권1호
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• pp.86-88
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• 1997

Regional sympathetic blockade is the most effective treatment for reflex sympathetic dystrophy (RSD). Radiofrequency thermocoagulation provides longer duration of pain relief than local anesthetics and less complication than chemical neurolytic agents for lumbar sympathectomy. Spinal cord stimulation (SCS) is thought to be an effective modality yieding good results in treating intractable neuropathic pain. Therefore RSD might be a good indication for SCS. We treated a patient with RSD who responded well to lumbar sympathetic blockade (LSB) with radiofrequency thermocoagulation and SCS. The patient had a left ankle sprain requiring a case for the lower leg for 2 weeks. The patient suffered increasing pain and swelling on the lower part of that leg. We thought to block the lumbar sympathetic chain utillzing radiofrequency thermocoagulation 2 days after LSB with local anesthetics. The results provided accepatable pain relief (VAS $8{\rightarrow}15$) but the patient still could not walk due to remaining pain which was further aggravated by walking. After SCS, pain relief improved (VAS $5{\rightarrow}13$) and patient could walk without assistance.