Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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2-Step Needle Insertion Technique to Reduce Pain in Children during Local Anesthesia

소아환자의 국소마취 시 통증을 줄이기 위한 2단계 주사바늘 자입법

  • Park, Suyoung (Department of Pediatric Dentistry, School of Dentistry, Chosun University) ;
  • Lee, Sangho (Department of Pediatric Dentistry, School of Dentistry, Chosun University) ;
  • Lee, Nanyoung (Department of Pediatric Dentistry, School of Dentistry, Chosun University) ;
  • Jih, Myeongkwan (Department of Pediatric Dentistry, School of Dentistry, Chosun University)
  • 박수영 (조선대학교 치과대학 소아치과학교실) ;
  • 이상호 (조선대학교 치과대학 소아치과학교실) ;
  • 이난영 (조선대학교 치과대학 소아치과학교실) ;
  • 지명관 (조선대학교 치과대학 소아치과학교실)
  • Received : 2019.10.23
  • Accepted : 2019.11.21
  • Published : 2020.05.31
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Abstract

This study was performed to evaluate the effectiveness of the 2-step needle insertion technique to reduce pain during local anesthesia in children. Local anesthesia was performed bilaterally using conventional technique and a 2-step technique, and to compare the degree of pain using the 2-step with that using the conventional technique during local anesthesia using a pain scale. The pain scores were significantly different between the conventional technique and the 2-step insertion technique at 5.82 ± 2.14 and 2.57 ± 2.09, respectively (p < 0.001). The subjective degree of pain based on gender, age, and Frankl's behavior rating scale was significantly lower in the 2-step insertion technique (p < 0.001). Subjective pain levels in the area of maxilla and mandible, anterior and posterior parts were lower in the group treated using the 2-step insertion technique (p < 0.001). The 2-step insertion technique is a simple and effective way to reduce pain during local anesthesia not only in children with a positive attitude to dental treatment, but also in children with negative attitudes, and is thought to be more effective if combined with application of topical anesthesia or distraction.

이 연구의 목적은 어린이의 구강내 국소마취시 통증을 줄이기 위한 방법으로 고안된 2-단계 자입법(2-step needle insertion technique)의 효과를 평가하기 위하여, 어린이 환자의 구강 내에 양측성으로 국소마취를 시행하고 마취시 느끼는 통증의 정도를 pain scale을 이용, 측정하여 통상적인 자입법(Conventional needle insertion technique)과 비교하는 것이다. 통상적인 자입법과 2-단계 자입법에 의해 어린이가 느낀 통증 점수는 각각 5.82 ± 2.14 and 2.57 ± 2.09로 통계적으로 유의한 차이를 보였다(p < 0.001). 성별, 연령, 그리고 Frankl의 행동평가척도에 따른 두 방법 간의 주관적인 통증의 정도는 2-단계 자입법에서 훨씬 작았다(p < 0.001). 부위별 마취법에 따른 주관적인 통증의 정도는 상악과 하악, 전치부와 구치부 등 모든 부위에서 2-단계 자입법으로 마취하는 동안의 통증이 더 작게 나타났다(p < 0.001). 2-단계 자입법은 치과치료에 긍정적인 태도를 가지는 어린이 뿐만 아니라 부정적인 태도를 가진 어린이 환자들에서도 국소마취시 통증을 감소시킬 수 있는 간단하고 효과적인 방법이며, 도포마취제의 적용이나 주의분산 등과 함께 병용한다면 통증을 더 효과적으로 감소시킬 수 있을 것으로 사료된다.

Keywords

References

  1. Nuttall NM, Bradnock G, Nunn J, et al. : Dental attendance in 1998 and implications for the future. Br Dent J, 190:177-182, 2001. https://doi.org/10.1038/sj.bdj.4800918a
  2. Baghdadi DZ : Evaluation of electronic dental anesthesia in children. Oral Surg Oral Med Oral Pathol Oral Radiol and Endod, 88:418-423, 1999. https://doi.org/10.1016/S1079-2104(99)70055-7
  3. Shilpapriya M, Jayanthi M, Vijayakumar P, et al. : Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children. J Indian Soc Pedod Prev Dent, 33:173-176, 2015. https://doi.org/10.4103/0970-4388.160343
  4. Abdelmoniem SA, Mahmoud SA : Comparative evaluation of passive, active, and passive-active distraction techniques on pain perception during local anesthesia administration in children. J Adv Res, 7:551-556, 2016. https://doi.org/10.1016/j.jare.2015.10.001
  5. Fiset L, Milgrom P, Glassman P, et al. : Psychophysiological responses to dental injections. J Am Dent Assoc, 111:578-583, 1985. https://doi.org/10.14219/jada.archive.1985.0160
  6. Lee JC, Kim DE, Yang KS, et al. : Local anesthesia in children using jet injection instrument. J Korean Acad Pediatr Dent, 28:633-637, 2001.
  7. Locker D, Shapiro D, Liddell A : Who is dentally anxious? Concordance between measures of dental anxiety. Community Dent Oral Epidemiol, 24:346-350, 1996. https://doi.org/10.1111/j.1600-0528.1996.tb00874.x
  8. Ram D, Peretz B : Administering local anaesthesia to paediatric dental patients - current status and prospects for the future. Int J Paediatr Dent, 12:80-89, 2002. https://doi.org/10.1046/j.1365-263X.2002.00343.x
  9. Malamed SF : Local anesthesia. J Calif Dent Assoc, 26:657, 660, 1998.
  10. Aminabadi NA, Farahani RM, Oskouei SG : Site-specificity of pain sensitivity to intraoral anesthetic injections in children. J Oral Sci, 51:239-243, 2009. https://doi.org/10.2334/josnusd.51.239
  11. Sandeep V, Kumar M, Jyostna P, Duggi V : Evaluation of 2-stage injection technique in children. Anesth Prog, 63:3-7, 2016. https://doi.org/10.2344/0003-3006-63.1.3
  12. Asarch T, Allen K, Petersen B, Beiraghi S : Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent, 21:421-424, 1999.
  13. Hochman M, Chiarello D, Pergola S, et al. : Computerized local anesthetic delivery vs. traditional syringe technique. Subjective pain response. N Y State Dent J, 63:24-29, 1997.
  14. Saravia ME, Bush JP : The needleless syringe: efficacy of anesthesia and patient preference in child dental patients. J Clin Pediatr Dent, 15:109-112, 1991.
  15. Nusstein J, Steinkruger G, Weaver J et al. : The effects of a 2-stage injection technique on inferior alveolar nerve block injection pain. Anesth Prog, 53:126-130, 2006. https://doi.org/10.2344/0003-3006(2006)53[126:TEOASI]2.0.CO;2
  16. Walton RE, Reader A, Nusstein JM : Local anesthesia. In: Torabinejad M, Walton RE, eds. Endodontics Principles and Practice, 4th ed. Saunders Elsevier, St Louis, 129-147, 2008.
  17. Levine A : Preventing pain: the one-two injection. Tic, 27:6, 1968.
  18. Ten Cate AR : Oral histology: Development, Structure, and Function, 4th ed.(Translation) Scientific book center, Seoul, 420-422, 1996.
  19. Lee DW, Baik BJ, So YR, et al. : Comparative efficacy of 5% EMLA cream and 20% Benzocaine gel during topical anesthesia. J Korean Acad Pediat Dent, 38:1-8, 2011.
  20. Yun PY, Kim YK : Study on effect of pressure-controlled injection system in dental local anesthesia. J Dent Anesth Pain Med, 6:98-102, 2006.
  21. Huskinson EC : Measurement of pain. Lancet, 304:1127-1131, 1974. https://doi.org/10.1016/S0140-6736(74)90884-8
  22. Krane JE, Tyler DC : Post operative pain management in children. Anaesth Clin North America, 7:159-160, 1989.
  23. Huskinson EC : Visual analogue scales. In Melzack R: Pain measurement and assessment. New York Raven, Press, 33-37, 1983.
  24. von Baeyer CL : Children's self-reports of pain intensity: scale selection, limitations and interpretation. Pain Res Manag, 11:157-162, 2006. https://doi.org/10.1155/2006/197616
  25. Nanci A : Ten Cate's Oral Histology, 8th ed.(Translation) DeahanNarae Publishing INC, Seoul, 277-308, 2014.
  26. Campbell AH, Stasse JA, Lord GH, Nilson JE : In vivo evaluation of local anaesthetic applied topically. J Pharm Sci, 57:2045-2048, 1968. https://doi.org/10.1002/jps.2600571204
  27. Fuller NP, Menke RA, Meyers WJ : Perception of pain to three different intraoral penetrations of needles. J Am Dent Assoc, 99:822-824, 1979. https://doi.org/10.14219/jada.archive.1979.0384
  28. Mollen AJ, Ficara AJ, Provant DR : Needles-25 gauge versus 27 gauge-can patients really tell? Gen Dent, 29:417-418, 1981.
  29. Flanagan T, Wahl MJ, Schmitt MM, Wahl JA : Size doesn't matter: needle gauge and injection pain. Gen Dent, 55:216-217, 2007.
  30. Lehtinen R : Penetration of 27- and 30-gauge dental needles. Int J Oral Surg, 12:444-445, 1983. https://doi.org/10.1016/s0300-9785(83)80036-2
  31. Forrest JO : A survey of the equipment of local anaesthesia. Br Dent J, 124:303-309, 1968.
  32. Farsakian LR, Weine FS : The significance of needle gauge in dental injections. Compend Contin Educ Dent, 12:262, 264-268, 1991.
  33. Candiotti K, Rodriguez Y, Birnbach DJ, et al. : The effect of needle bevel position on pain for subcutaneous lidocaine injection. J Perianesth Nurs, 24:241-243, 2009. https://doi.org/10.1016/j.jopan.2009.04.003
  34. Registered Dental Hygenist MAGAZINE : Pain control in dental hygiene. Available from URL: https://www.rdhmag.com/patient-care/rinses-pastes/article/16408494/pain-control-in-dental-hygiene (Accessed on November 18, 2019).
  35. Gores KW : Method of forming bevel oriented needle arrangement, U.S. Patent, 3,662,457, 1972.
  36. Quarnstrom F, Libed EN : Electronic anesthesia versus topical anesthesia for the control of injection pain. Quintessence International, 25:713-716, 1994.
  37. Wilson S, Molina LL, Preisch J, Weaver J : The effect of electronic dental anesthesia on behavior during local anesthetic injection in the young, sedated dental patient. Pediatr Dent, 21:12-17, 1999.
  38. Hegde KM, R N, Radhakrishna S, et al. : Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6-11 years: A crossover split-mouth study. J Dent Anesth Pain Med, 19:143-149, 2019. https://doi.org/10.17245/jdapm.2019.19.3.143
  39. Primosch RE, Brooks R : Influence of anesthetic flow rate delivered by the Wand Local Anesthetic System on pain response to palatal injections. Am J Dent, 15:15-20, 2002.
  40. Kaufman E, Epstein JB, Cohen G, et al. : A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog, 52:122-127, 2005. https://doi.org/10.2344/0003-3006(2005)52[122:ASP]2.0.CO;2
  41. Aminabadi NA, Farahani RM, Oskouei SG : Site-specificity of pain sensitivity to intraoral anesthetic injections in children. J Oral Sci, 51:239-243, 2009. https://doi.org/10.2334/josnusd.51.239
  42. Ram D, Peretz B : The assessment of pain sensation during local anesthesia using a computerized local anesthesia (Wand) and a conventional syringe. J Dent Child, 70:130-133, 2003.
  43. Ram D, Peretz B : Reaction of children to maxillary infiltration and mandibular block injections. Pediatr Dent, 23:343-346, 2001.
  44. Allin KD, Kotil D, Beiraghi S : Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatr Dent, 24:315-320, 2002.
  45. Peretz B, Efrat J : Dental anxiety among young adolescent patients in Israel. Int J Paediatr Dent, 10:126-132, 2000. https://doi.org/10.1046/j.1365-263x.2000.00181.x
  46. Jeske AH, Blanton PL : Misconceptions involving dental local anesthesia. Part 2: Pharmacology. Tex Dent J, 119:310-314, 2002.