• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.5
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• pp.271-279
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• 2020

Background: The present study aimed to evaluate and compare the efficacy of buffered and unbuffered local anesthesia solutions during inferior alveolar nerve block (IANB) administration in children. Methods: PubMed, Ovid SP, and Cochrane databases were searched separately by two independent reviewers for potential papers published between 1980 and April 2020 using relevant MeSH terms and pre-specified inclusion and exclusion criteria. T Studies of IANB administration in children comparing buffered and unbuffered local anesthesia solutions were evaluated. The primary outcome evaluated was pain (perception and reaction), while the secondary outcome was the onset of anesthesia. Results: A total of five articles were included in a qualitative analysis; among them, four qualified for quantitative analysis of the primary outcome and three for quantitative analysis of the secondary outcome. A fixed-effects model was used to perform the meta-analysis. Pain perception (child-reported pain): Significantly lower pain scores were reported with buffered local anesthesia solution than with unbuffered solution (P = 0.006, MD: -0.32, 95% CI: -0.55 to -0.09). Pain reaction (observer-reported pain reaction in child): No significant difference was found between buffered and unbuffered solution in terms of observer-reported pain behavior in the child (P = 0.09, MD: -0.21, 95% CI: -0.46 to 0.04). Onset of anesthesia: A significantly lower duration of anesthesia onset was reported with buffered local anesthesia solution than with unbuffered solution (P = 0.00001, MD: -12.38, 95% CI: -17.64 to -7.13]. Conclusion: Buffering local anesthesia solution may reduce discomfort due to IANB injection administration and lower the initial onset time of anesthesia. More randomized control trials with adequate sample sizes should be carried out to validate the accuracy of these results.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.4
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• pp.337-344
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• 2021

Background: The primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia. Methods: Fifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20-60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively. Results: The results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group. Conclusion: Ropivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.1
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• pp.1-8
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• 2023

Backgrounds: Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-in^TM) and the classic needle method during treatment-required infiltration anesthesia in children. Methods: This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05. Results: There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750). Conclusions: The needle-free injection system was as effective as the dental needle method. The Comfort-in^TM system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.183-190
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• 2017

Background: It is important to evaluate preoperative anxiety and prepare sedation when performing dental surgery under local anesthesia. Spielberger's State-Trait Anxiety Inventory (STAI) is useful for predicting preoperative anxiety. State anxiety is defined as a subjective feeling of nervousness. Reduction in the number of the state anxiety items (questions) will be clinically important in allowing us to predict anxiety more easily. Method: We analyzed the STAI responses from 1,252 patients who visited our institution to undergo dental surgery under local anesthesia. Multiple linear regression analysis was conducted for 9 groups comprising anxiety level determinations using the STAI; we then developed a coefficient of determination and a regression formula. We searched for a group satisfying the largest number of requirements for regression expression while setting any necessary conditions for accurately predicting anxiety before dental surgery under local anesthesia. Results: The regression expression from the group determined as normal for preoperative state anxiety was deemed the most suitable for predicting preoperative anxiety. Conclusion: It was possible to reduce the number of items in the STAI by focusing on "Preoperative anxiety before dental surgery."

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.172-177
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• 2010

Background: Damages of trigeminal nerve, particularly inferior alveolar nerve and lingual nerve, could occur following dental procedures. In some cases, nerve damage may happen as a complication of the local anesthetic injection itself and not of the surgical procedure. Methods: From September 2006 to August 2010, 5 cases of inferior alveolar nerve and lingual nerve damages, which were assumed to happen solely due to local anesthesia, were reviewed. All cases were referred to Division of Oral and Maxillofacial Surgery, Department of Dentistry, Hanyang University Medical Center for legal authentication in the process of criminal procedure. Results: In all five cases, patients complained of altered sensation occurred in the distribution of the inferior alveolar or lingual nerve following block anesthesia. The local anesthetics were 2% lidocaine with 1 : 100,000 epinephrine and the amount of local anesthetics, which were used during injection, were varied. Most of patients experienced the electric stimulation during injection. Recovery was poor and professional supportive care was mostly absent. Conclusions: Dental practitioners should consider that the surgical procedure caused the trigeminal nerve damage, however, dental local anesthesia for inferior alveolar nerve and lingual nerve could be one of the causes for damages. The various mechanisms for nerve damages by local anesthesia are thoroughly discussed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.181-189
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• 2019

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor, confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.119-127
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• 2020

This study was conducted to determine how precooling reduces the subjective reported pain and objective pain and to evaluate the effectiveness of precooling the injection site before administration of local anesthesia in children. Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched for publications from 1980 to 2020. Studies were screened for titles and abstracts, followed by full-text evaluation of included reports. Six studies were included in this systematic review. The primary outcome evaluated was the pain perception or the subjective pain reported by the child receiving the injection. The secondary outcome evaluated was objective pain evaluated in each study. Among 5 studies that evaluated child reported pain scores on a visual analogue scale (VAS), 4 studies reported lower scores in the precooling group and one study reported a higher VAS score in the precooling group than in children treated with 20% benzocaine topical anesthesia. Among 6 studies that evaluated the pain reaction of children by Sound Eye Motor (SEM) score, 4 studies reported a lower SEM score in the precooling group, one study reported no significant difference between the precooling and control groups, and one study reported higher SEM scores in the precooling group than in children treated with 20% benzocaine topical anesthesia. Within the limits of this systematic review, evidence suggests that precooling the injection site with ice can be an effective adjunct to topical anesthesia in reducing both subjective and objective pain during local anesthesia administration in children.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.287-294
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• 2018

Mandibular third molar extraction is commonly performed in dental clinics. However, the optimal method of anesthesia has not been established for this procedure. The conventional inferior alveolar nerve block is the most widely used method. However, its success rate is not high and it may lead to complications, such as aspiration and nerve injury. Therefore, various anesthesia methods are being investigated. Articaine has been proven to be efficacious in a number of studies and is being used with increasing frequency in clinical practice. In this review article, we will briefly review various local anesthesia techniques, anesthetics, and a computer-controlled local anesthetic delivery (CCLAD) system, which reduces pain by controlling the speed of drug injection, for mandibular third molar extraction.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.6
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• pp.337-346
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• 2023

Background: This study aimed to investigate the effect of local anesthesia (LA) on postoperative pain and hemostasis after dental rehabilitation under general anesthesia (DRGA) in pediatric patients. Methods: A total of 43 patients, aged 3-7 years and rated ASA I or II, who had a definitely negative rating on Frankel's behavior rating scale, were included in this two-arm, parallel-design, single-blinded, randomized, controlled study. The patients were allocated equally into two main groups receiving both restorative treatments and tooth extractions. Two pain scales and one bleeding scale were used. In Group A, the treatment was done with LA, and in Group B, the treatment was done without LA. Results: The statistical analysis revealed no significant differences in the pain scores between the groups. It also revealed significant differences in the bleeding scores between the groups but no significant differences in the duration of bleeding. Conclusion: Within the limitations of this study, the use of LA in pediatric dental patients undergoing DRGA had no effects on postoperative pain reduction or bleeding duration after teeth extraction. We also observed that the use of LA had an impact on the reduction in the bleeding scores in pediatric dental patients undergoing DRGA.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.5
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• pp.451-459
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• 2021

Background: Lignocaine with adrenaline is routinely used as a local anesthetic for dental procedures. Adrenaline was added to increase the duration of anesthesia. However, epinephrine containing a local anesthetic solution is not recommended in conditions such as advanced cardiovascular diseases and hyperthyroidism. Recently, ropivacaine has gained popularity as a long-acting anesthetic with superior outcomes. The goal of this study was to assess and compare the effectiveness of 0.75% ropivacaine alone and 2% lignocaine with adrenaline (1:80,000) in the removal of bilateral maxillary wisdom teeth using the posterior superior alveolar nerve block technique. Methods: This was a single-blind, randomized, split-mouth, prospective study assessing 15 systemically sound outpatients who needed bilateral removal of maxillary third molars. We randomly allocated the sides and sequences of ropivacaine and lignocaine with adrenaline administration. We evaluated the efficacy of both anesthetics with regard to the onset of anesthesia, intensity of pain, variation in heart rate, and blood pressure. Results: The onset of anesthesia was faster with lignocaine (138 s) than with ropivacaine (168 s), with insignificant differences (p = 0.001). There was no need for additional local anesthetics in the ropivacaine group, while in the lignocaine with adrenaline group, 2 (13.3%) patients required additional anesthesia. Adequate intraoperative anesthesia was provided by ropivacaine and lignocaine solutions. No significant difference was observed in the perioperative variation in blood pressure and heart rate. Conclusion: Ropivacaine (0.75%) is a safe and an adrenaline-free local anesthetic option for posterior superior alveolar nerve block, which provides adequate intraoperative anesthesia and a stable hemodynamic profile for the removal of the maxillary third molar.