Buccal Nerve Block Research Articles

Anaesthetic Efficacy of Adjunct Therapy with Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomised Controlled Study

Abstract Objective: The aim of this prospective, randomised controlled study was to evaluate the efficacy of pulpal anaesthesia in the management of pain in mandibular first molars with symptomatic irreversible pulpitis (SIP) in relation to alternative adjunct therapies with a conventional inferior alveolar nerve block (IANB) versus the conventional IANB technique. Methods: In accordance with the CONSORT statement, a prospective, randomised controlled parallel-design clinical trial was created. Group 1: Conventional IANB (Control group); Group 2: IANB plus local infiltration; Group 3: IANB plus long buccal nerve block; Group 4: IANB plus premedication with paracetamol; and Group 5: IANB plus cryotherapy was the five groups comprised 50 participants who met the inclusion and exclusion criteria. People were asked to use the Heft-Parker Visual Analogue Scale (HP-VAS) to score their level of discomfort at three separate intervals during the treatment process: before treatment, during access opening, and during pulp extirpation. Results: During access opening, Tukey’s post hoc multiple comparison tests showed statistically highly significant differences (P < 0.001) between Group 1 and Group 4 and a statistically significant difference (P < 0.05) between Group 1 and Group 3. During pulp extirpation statistically significant difference (P < 0.05) between Group 1 and Group 4 were reported. While the other group shows a statistically insignificant difference. Conclusion: IANB alone does not provide painless endodontic treatment in SIP patients. Hence, adjunct therapy of premedication with paracetamol or a supplementarily anaesthetising long buccal nerve block can significantly increase anaesthetic efficacy of IANB.

Achieving the minimum pain experience by buccal nerve and superficial cervical plexus blocks in radiofrequency treatment.

Thermage is a monopolar radiofrequency (RF). It has become an indispensable part of facial and body youthful methods. Although the current device is constantly improving in epidermal cooling techniques and even automatically measures the local impedance value, applying surface anesthesia can take some of the pain away caused by thermage, and the patient's severe pain in the jaw and neck areas is still difficult to resolve. The author describes how he uses the combination of the buccal nerve block (BNB) and the superficial cervical plexus block (SCPB) to improve the comfort of the patient's face and neck treatment of patients. It can improve the quality, elasticity, and texture of the skin. According to the author's knowledge of oral and maxillofacial surgery, the combination of BNB and SCPB is applied to the neck and facial analgesia. Combining the BNB and SCPB effectively provides facial and neck anesthesia. The BNB in this technique provides pain relief to the facial skin in the mandibular area and SCPB offers pain relief to the skin of the neck. RF facial rejuvenation treatment often involves the junction of the face and neck to improve the contour of the mandibular margin. Therefore, Whether the RF treatment is aimed at the face or neck, or the treatment is performed simultaneously, we advocate the block both of the buccal nerve and the superficial cervical plexus nerves to achieve perfect analgesia. Still, the dosage of anesthetic medication for the nerve block can be adjusted according to the treatment area. We applied these two nerve blocks and their combination to improve skin laxity with RF therapy for the first time.

Inferior Alveolar Plus Buccal Nerve Block Decreases Postoperative Pain Scores at Buccal Mucosal Graft Harvest Site: A Retrospective Analysis.

Postoperative pain at buccal mucosal graft (BMG) harvest site hinders the resumption of food intake. We aim to study the effect of inferior-alveolar nerve block plus buccal nerve block (IANB+BNB) on pain scores. This was a retrospective case-control study performed in a single center from July 2021 to July 2022 (ethics committee approval: T/IM-NF/Urology/23/27). We performed IANB+BNB with a mixture of 5 mL each of 1% lignocaine and 0.25% bupivacaine and 4 mg dexamethasone, in addition to local infiltration of 2% lignocaine and (1:100000) epinephrine combination before harvesting BMG. We retrospectively compared the recorded postoperative pain scores using the visual analog scale (VAS) among patients who received and did not receive IANB+BNB. The time for resumption of pain-free diets and postoperative analgesic requirements was compared. The study groups included 20 patients each and were similar in age and graft size. The VAS scores at 0 hours [1.0 (1.25) vs. 2.5 (3.5); P= .043], 6 hours [2.40 (± 0.69) vs. 4.60 (± 0.97); P= .008], 12 hours [2.50 (± 0.97) vs. 4.80 (± 0.92); P= .008], and 24 hours [3.0 (1.25) vs. 4.5 (1.25); P= .002] were better in the intervention arm. However, the pain beyond the second day was similar. The IANB+BNB group resumed solid food quicker, and the cumulative paracetamol dose required was less [8.9 (± 3.03) vs. 16.2 (± 5.06) g; P= .001]. Fewer patients required opioids. Patients who received IANB+BNB had better pain scores during the first 24 hours following surgery and tolerated solid diet quicker.

Efficacy of Eutectic Mixture of Local Anesthetics (EMLA) Versus Ice as Topical Anesthetics Prior to Long Buccal Nerve Blocks: A Prospective Comparative Study.

Background Dental extraction is one of the common procedures in the field of dentistry. However, fear and anxiety about local anesthetic injections are unavoidable for most patients.Topical anesthetics, distraction techniques, acupuncture, and the application of heat or cold have been used in practice to alleviate injection-related pain. The specific aim of this study was to compare the pain-relieving efficacy of eutectic mixture of local anesthetics (EMLA) vs. ice during the administration of a long buccal nerve block (LBNB) before dental extraction. Materials and Methods In total, 20 healthy adult patients who required bilateral mandibular posterior teeth extraction under local anesthesia were enrolled.The study was conducted in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, from January 2023 to May 2023. It was a prospective split-mouth study in which each participant was divided into two groups according to the operative site: Group 1, which received a 5% EMLA cream, and Group 2, which received an application of ice before administration of LBNB. There was a one-week interval between the two interventions. The levels of pain and satisfaction were assessed using the visual analogue scale (VAS) and pain perception was evaluated by the sound, eye, motor (SEM) scale. Mann-Whitney U test was applied for the statistical analysis. Results The study included a total of 20 participants, with 14 being male and six being female. The mean age of the study population was 42 ± 15 years. When analyzing the pain scores using the VAS, it was found that Group 1 had a mean score of 2.4 ± 0.44, while Group 2 had a mean score of 3.0 ± 0.44. This differencebetween the two groups wasstatistically significant (P = 0.001). It was also found that the mean patient satisfaction score for Group 1 was 9.8 ± 0.22 and for Group 2 was 9.2 ± 0.40 which wasstatistically significant (p = 0.003). Similarly, Group 1 had a mean SEM score of 1.1 ± 0.1, while Group 2 had a mean SEM score of 1.30 ± 0.46 which was also statistically significant (P =0.016). Conclusion The study results revealed that EMLA has asignificant advantage over ice in terms of lower levels of pain, more patient satisfaction, and higher comfort levels.EMLA can be considered the first choice of topical anesthetics, however, ice is recommended in resource-constrained dental set-upsas it is cost-effective.

Comparative Evaluation of the Anesthetic Efficacy of 1% Chloroprocaine Vis-a-vis 2% Lignocaine with Adrenaline (1:80,000) in Third Molar Surgery.

To evaluate the anesthetic efficacy of 1% chloroprocaine in comparison to 2% lignocaine hydrochloride and adrenaline (1:80,000) in third molar surgery. A randomized single-blind trial comprising of 30 healthy patients requiring bilateral extraction of impacted lower third molars with similar difficulty index was undertaken. A test dose was administered to all patients with subdermal infiltration of 1% chloroprocaine with 0.5ml. A classic inferior alveolar and long buccal nerve block was given using 1% chloroprocaine 2ml on one side and 2% lignocaine hydrochloride 2ml with adrenaline on the other side. The time to onset and duration of action were noted. Pain during the surgical intervention, need for additional local anesthetic solution during the surgical intervention and the hemodynamic changes associated with the administration of the drugs were monitored. Chloroprocaine had an early onset of action with a mean of 1.17 ± 0.55min as compared to lignocaine 4.2 ± 0.48min. Patients administered with lignocaine experienced less postoperative pain compared with chloroprocaine since the duration of action of chloroprocaine was lesser than that of lignocaine. Additional amount of LA was required when chloroprocaine was administered as compared to lignocaine. Chloroprocaine alone did not cause any appreciable changes in the hemodynamics, but lignocaine with adrenaline caused a transient increase in arterial pressure and heart rate 2min following the administration. It was also observed that more blood was lost following chloroprocaine administration than with lignocaine. Chloroprocaine has a rapid onset of action and short duration of action with minimal effects on the hemodynamic changes than lignocaine. Considering the fact that it is a safe drug with no effects of the cardiovascular system it can be advocated that Chloroprocaine can be used as an effective local anesthetic agent for performing oral and maxillofacial surgical interventions of short duration.

SCPNB is an adjuvant to local anaesthesia for maxillofacial surgical practice.

The superficial cervical plexus nerve block [SCPNB] procedure is frequently used throughout head and neck surgery because it is simple to learn and has a low rate of complications. The investigation of this method might produce superior outcomes in treating frequent maxillofacial disorders including mandibular fractures and infections of the odontogenic region. The SCPNB is known to play a part in the medical evacuation of head and neck abscesses, the excision of superficial diseases in the perimandibular region, and the therapy of mandibular fracture, despite the dearth of research in this area. Considering this background, it was expected that the SCPNB might be helpful as an adjuvant to regional anaesthesia in maxillofacial surgery. The purpose of this study was to assess the effectiveness of the SCPNB in the treatment of mandibular fractures and infectious diseases in the perimandibular area. 48 patients with either submandibular space infections or mandibular injuries who were anticipated for surgical procedure under regional anaesthesia participated in a prospective randomized clinical study (eg, inferior alveolar nerve block, long buccal nerve block). Administering a combination of a local infiltration and regional anaesthesia was used as the control group. Regional anaesthesia and a SCPNB were administered to the intervention class. The following factors were examined: pain, anaesthesia's duration and onset, waiting period before initial analgesic demand, pulse rate, and blood pressure. The unpaired t-test was used to compare groups. Multiple variables ANOVA (for more than two observations) was used for intragroup analysis, accompanied by a post-hoc analysis of variance. In aspects of intra - operative pain at thirty minutes, time required of anaesthesia, intraoperative anesthetic necessity, duration until first analgesic recommendation, and intra - operative diastolic arterial blood pressure at ten minutes, the SCPNB group demonstrated a substantial (P ≤.01) improved performance. It can be concluded that the use of a regional anaesthetic approach in conjunction with a SCPNB is a good substitute to localized infiltration for patients having surgery for fracture of mandible and perimandibular area infections.

Narcotic Requirements before and after Implementation of Buccal Nerve Blocks for Buccal Mucosa Graft Harvest: Technique and Retrospective Review

The reduction in opioid use has become a public health priority. We aimed to assess if performing buccal nerve blocks (BNB) at the time of buccal mucosa graft (BMG) harvest impacts post-operative narcotic usage in the inpatient setting. We retrospectively reviewed clinical characteristics and morphine milligram equivalents (MMEs) received for all patients that underwent a BMG urethroplasty at our institution. The primary outcome measure was post-operative MMEs for patients before and after implementing the BNB. We identified 74 patients that underwent BMG urethroplasty, 37 of which were before the implementation of the BNB and 37 of which were after. No other changes were made to the peri-operative pathway between these time points. The mean total MMEs per day, needed post-operatively, was lower in the BNB group (8.8 vs. 5.0, p = 0.12). A histogram distribution of the two groups, categorized by number of MMEs received, showed no significant differences between the two groups. In this retrospective analysis, we report our experience using BNBs at the time of buccal mucosa graft harvest. While there were no significant differences between the number of MMEs received before and after implementation, further research is needed to assess the blocks' impact on pain scores.

Buccal Nerve Trunk Block Anesthetizes the Buccal Mucosa Beyond the Papilla of the Parotid Duct

The limited area of anesthesia of the buccal mucosa with concomitant conventional buccal nerve block (conventional BNB) may be involved in failed inferior alveolar nerve block (IANB). The aims of this study were to examine the extent of anesthesia by buccal nerve trunk block (BNTB) and compare the success rates of IANB with BNB. This prospective parallel-group randomized single-blinded clinical trial included patients scheduled for removal of a mandibular third molar at the Nippon Dental University Hospital between September 2021 and March 2022. The primary predictor variable was the approach for BNB (BNTB vs conventional BNB). The primary outcome was the extent of tactile sensory loss and anesthesia of the buccal mucosa. The secondary outcomes included onset time and duration of BNBs and the success rate of the IANB with concomitant BNB for third molar extraction, assessed by the proportions of intraoperative pain perception and supplemental infiltration anesthesia. The other study variables were sex, age, and injection side. Comparisons were analyzed by Fisher's exact test or the Mann-Whitney U test. The P value was set to .05. A total of 38 patients (14 male, 24 female) with a mean age of 28.9years (range, 18 to 67years) were enrolled, with 19 patients each in the BNTB group and conventional BNB group. The effective tactile sensory loss rates at ∼5mm above the height of the papilla of the parotid duct of the premolar and molar regions were greater following BNTB (71 and 95%, respectively) than following conventional BNB (37%; P<.01 and 58%; P<.01, respectively). The proportions of intraoperative pain perception of the BNTB group and the conventional BNB group were 10 and 42% (P=.06), respectively, and those of supplemental infiltration anesthesia were 5 and 26% (P=.18), respectively. BNTB provided a wider extent of anesthesia of the buccal mucosa than conventional BNB and may improve the anesthesia success of IANB for removal of mandibular third molars.

MP03-19 SUPPORT FOR MINIMIZING NARCOTIC REQUIREMENT FOLLOWING URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP03)1 Sep 2021MP03-19 SUPPORT FOR MINIMIZING NARCOTIC REQUIREMENT FOLLOWING URETHROPLASTY Chase Mallory, Alejandra Perez, Adam Nolte, Scott Jamieson, Jessica Boyer, Dhaval Jivanji, Spencer Liem, and Billy Cordon Chase MalloryChase Mallory More articles by this author , Alejandra PerezAlejandra Perez More articles by this author , Adam NolteAdam Nolte More articles by this author , Scott JamiesonScott Jamieson More articles by this author , Jessica BoyerJessica Boyer More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Spencer LiemSpencer Liem More articles by this author , and Billy CordonBilly Cordon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001964.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The opioid epidemic has led to increased use of non-narcotic post-surgical pain management. While many studies have assessed preoperative adjunct measures to decrease postoperative narcotic requirements, few studies have looked directly at optimal postoperative pain management following urethroplasty both in the peri- and postoperative settings and upon discharge. In this study, we aim to characterize pain control for patients undergoing urethroplasty and provide alternative non-narcotic adjuncts. METHODS: We retrospectively reviewed clinical and procedural characteristics for all patients that underwent urethroplasty at our institution from August 2016 through February 2021. The primary outcome was milligram morphine equivalents (MME) which is the amount of morphine (mg) equal to the strength of opioid prescribed. We utilized peripheral nerve blocks intraoperatively including a pudendal block along with a long buccal nerve block prior to buccal mucosa harvest, performed by infiltrating the buccal sulcus just distal to the last molar tooth. This strategy was implemented on December 2018 in efforts to decrease perioperative morbidity associated with buccal harvest. RESULTS: We identified 77 patients that underwent urethroplasty: 58% augmented and 26% anastomotic. 60% of patients did not receive any narcotics in the immediate postoperative period while 32.5% received 0.1-5 MME, and only 6.5% received >5 MME. When comparing groups before and after implementation of buccal nerve block, patients received 3.7 vs 1.18 MME (p=0.021) in the immediate postop period and 15.8 and 8.9 ME (p= 0.22) during admission. When breaking down by surgery type, we also noted a trend for patients who had augmented urethroplasty to have higher MME requirements. CONCLUSIONS: Non-narcotic alternatives following urethroplasty, such as NSAIDs and anticholinergics are viable options for pain control in certain patient cohorts. Our preliminary analysis demonstrates decreased need for post-operative narcotic pain control with intra-operative nerve blocks. Further studies will focus on identifying patient factors predictive of narcotic requirement to build an algorithmic approach that would minimize narcotic use and ultimately addiction. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e28-e28 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chase Mallory More articles by this author Alejandra Perez More articles by this author Adam Nolte More articles by this author Scott Jamieson More articles by this author Jessica Boyer More articles by this author Dhaval Jivanji More articles by this author Spencer Liem More articles by this author Billy Cordon More articles by this author Expand All Advertisement Loading ...

Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial

The objective of this triple-blind, randomized, placebo-controlled trial was to assess the clinical analgesic efficacy of 0.5% bupivacaine in acute postoperative pain management after bilateral sagittal split ramus osteotomy (BSSO). Patients were randomly allocated into the experimental (0.5% bupivacaine with 1:200000 epinephrine) or control group (normal saline - placebo) using block randomization. The interventions were administered at the inferior alveolar nerve block and buccal nerve block sites bilaterally after the BSSO surgery. Analgesic efficacy was assessed in terms of the patient's pain perception measured by a numerical rating scale (0 to 10), rescue drug requirement, and duration of analgesia for 24 hours after the surgery. The statistical analysis was blinded to the allocation groups, and P-value of <.05 was considered as a significant difference for all tests. In total, 28 patients underwent BSSO (ie, 14 in each group). There was no significant difference in pain perception of patients injected with 0.5% bupivacaine and those administered with placebo during the 24 hours after the surgery (P > .05). Three patients in the bupivacaine group took the rescue drug after the surgery (mean duration - 268 minutes) and 1 patient in the placebo group took the rescue drug after 27 minutes. Postoperative use of bupivacaine did not show a superior analgesic efficacy when compared with normal saline in controlling acute postoperative pain after BSSO.

A Case of Multiple Mandibular Molar Extractions for a Hemophilia a Patient

Hemophilia A is a genetic coagulation disorder associated with a deficiency of clotting factor VIII. It can be inherited or acquired and have different levels of severity. The present case report describes a Libyan male patient with Factor VIII deficiency who underwent multiple remaining roots extraction.The patient was a 26-year-old Libyan male with history of hemophilia A of mild type. The patient underwent blood tests and imaging to assess the severity of hemophilia and the condition of the surgical area. The blood examination revealed normal Bilirubin level (0.6), low levels of, RBC (4.55), HGB (10.9), PT (17.7) and slight changes in platelet count and Factor VIII level. The treatment plan for the day of surgery was accordingly, the patient was administered Factor VIII 24 hours before the day of surgery. The patient underwent the multiple roots extraction of lower left first and second molar under local anesthesia using 2% Lidocaine with 1:80, 000 Adrenaline. The Injection technique was regional nerve block (inferior alveolar, Lingual, and long buccal nerve block).After extraction, direct pressure on the area using a damp gauze swab, maintained for at least 30 min, a hemostat and multiple thread suture were applied. One hour after surgical removal of the roots again the patient administered Factor VIII.There was no subsequent bleeding or complications at follow-up in the first three days. In the fourth day there was moderate bleeding at the extraction sockets continued for a day. At fifth day the patient was admitted at the Sebha Medical Centre. The bleeding stopped after 24 hours. Treatment plan in the Medical Centre was administration of factor FVIII, tranexamic acid 500 mg three times a day and vitamin K once a day. All injections were given intravenously. Then the patient discharged from the Centre in the sixth day after bleeding controlled. The wound had healed completely without abnormalities.

Role of Superficial Cervical Plexus Nerve Block as an Adjuvant to Local Anesthesia in the Maxillofacial Surgical Practice

Infiltration techniques are used as an adjuvant to regional anesthesia. In this study, we evaluated the efficacy of the superficial cervical plexus nerve block, as an alternative to local infiltration techniques; in the management of mandibular fractures and peri-mandibular space infections. A prospective randomized controlled trial was conducted on 24 patients having either mandibular fractures or peri-mandibular space infections; and were scheduled for surgery under regional anesthesia (eg, inferior alveolar nerve block, long buccal nerve block). The control group involved delivering a combination of regional anesthesia along with local infiltration. The experimental group received regional anesthesia with a superficial cervical plexus nerve block. The following parameters were studied: pain, onset and duration of anesthesia, time interval until first analgesic request, pulse rate and blood pressure [at different time intervals]. Intergroup comparison was done using unpaired t-test. Intragroup comparison was done using repeated measures ANOVA (for >2 observations), followed by a post hoc test. The superficial cervical plexus nerve block group showed highly statistically significant (P < .01) improvement in terms of intra-operative pain at 30 minutes, duration of anesthesia, intraoperative anesthetic requirement, time interval until first analgesic request and intraoperative diastolic blood pressure at 10 minutes. It can be concluded that the combination of a regional anesthesia technique with a superficial cervical plexus nerve block is an alternative and safe technique for patients undergoing surgery for mandible fractures and perimandibular space infections, with clear advantages over local infiltration.

A COMPARATIVE EVALUATION OF ANESTHETIC EFFICACY OF 4% ARTICAINE WITH 1:100000 EPINEPHRINE AND 2% LIDOCAINE WITH 1:100000 EPINEPHRINE FOR INFERIOR ALVEOLAR NERVE BLOCK AND LONG BUCCAL NERVE BLOCK DURING ROOT CANAL TREATMENT: AN IN VIVO STUDY

Background: It is important to control the pain associated with root canal treatment (RCT) in endodontic. Pain accompanying fear and anxiety due to endodontic treatment can be reduced by anesthetic techniques. The present study aims to compare the effect of articaine versus lidocaine local anesthesia for inferior alveolar nerve block (IANB) and long buccal nerve block on pain during RCT. METHODS: Twenty patients diagnosed with symptomatic irreversible pulpitis of mandibular posterior tooth were selected. The patients randomly received either cartridge of lidocaine or articaine using IANB and long buccal nerve block. The patients were randomly divided into two groups of ten. Group 1: patients received IANB and long buccal nerve block 2% lidocaine with 1:100000 epinephrine. Group 2: patients received IANB and long buccal nerve block with 4% articaine with 1:100000 epinephrine. Before the Injection, the patient received all information about the visual analysis scale (VAS). Pain was evaluated using VAS scale in numberic value 1 to 10 number. The pain was evaluated at three different stages: before administration of LA, after immediate access opening, and after immediate obturation procedure. Data were analyzed using various suitable statistical tests. RESULT: The mean value of efcacy of pain before administration of local anesthesia (LA) was 8.50 ± 0.97 for lidocaine and 8.30 ± 0.48 for articaine had no signicant difference. A signicant difference was observed at two different duration after immediate access opening and after immediate obturation where articaine has a lower mean value 3.60 ± 1.08 and 1.60 ± 0.17 respectively (P&gt;0.05) as compared to the mean value of lidocaine 4.10 ± 1.10 and 1.60 ± 0.17 respectively Conclusion: Within the limitations of the study, in cases of symptomatic irreversible pulpitis articaine 4% did not alleviate pain much and showed better anesthetic efcacy than 2% lidocaine with IANB and long buccal nerve block.

Single-insertion technique for anesthetizing the inferior alveolar nerve, lingual nerve, and long buccal nerve for extraction of mandibular first and second molars: a prospective study.

ObjectivesAppropriate and accurate local anesthetic (LA) techniques are indispensable in the field of oral and maxillofacial surgery to obtain a satisfactory outcome for both the operating surgeon and the patient. When used alone, the inferior alveolar nerve block (IANB) technique requires supplemental injections like long buccal nerve block for extraction of mandibular molars leading to multiple traumatic experiences for the patient. The aim of this study was to anesthetize the inferior alveolar, lingual, and long buccal nerves with single-needle penetration requiring a minimal skillset such as administering a conventional IANB through introduction of the Benny Joseph technique for extraction of mandibular molars.Materials and MethodsThis was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, Kunhitharuvai Memorial Charitable Trust (KMCT) Dental College, Calicut, India. The duration of the study was 6 months, from June to November 2017, with a maximum sample size of 616 cases. The LA solution was 2% lignocaine with 1100,000 adrenaline. The patients were selected from a population in the range of 20 to 40 years of age who reported to the outpatient department for routine dental extraction of normally positioned mandibular right or left first or second molars.ResultsOf the 616 patients, 42 patients (6.8%) required re-anesthetization, a success rate of 93.2%. There were no complications such as hematoma formation, trismus, positive aspiration, and nerve injuries. None of the cases required re-anesthetization in the perioperative period.ConclusionThe Benny Joseph technique can be employed and is effective compared with conventional IANB techniques by reducing trauma to the patient and also requires less technique sensitivity.

COMPARISON OF PAIN PERCEIVED BY PATIENTS UNDERGOING INTRA ORAL LOCAL ANESTHESIA USING DIFFERENT NEEDLE GAUGES

Objective: To compare the difference in pain perceived by patients undergoing intra-oral local anesthesia withdifferent gauge needles.&#x0D; Study Design: Qausi experimental study.&#x0D; Place and Duration of Study: Oral and Maxillofacial surgery department of Institute of Dentistry, CombinedMilitary Hospital, Lahore Medical College, Lahore, from July 2019 to August 2019.&#x0D; Methodology: One hundred patients were selected by consecutive sampling from the oral surgery OPD clinic.They were divided into two groups A and B randomly. Twenty three gauge needle on a 3cc disposable syringewas used for inferior alveolar nerve block and buccal nerve block for group A and 27 gauge needle on a metaldental syringe was used for the same in group B. Patients gave a verbal pain score, from 0-10 for each injection.&#x0D; Results: One Hundred participants were included in study, 37 (37%) males and 63 (63%) females. Mean painscore for group A for the inferior alveolar nerve block was 4.50 ± 2.1 and group B was 3.86 ± 2. The mean painscore for the buccal nerve block in group A was 4.02 ± 1.7, while that of group B was 3.94 ± 1.8. There was nosignificant difference (p=0.167 &amp; 0.855) in pain perceived by patients undergoing intra oral local anesthesia using needles of different gauges.&#x0D; Conclusion: There is no difference in pain perceived by patients undergoing intra oral local anesthesia usingneedles of different gauges.

Combined inferior alveolar nerve block anaesthesia and local infiltration anaesthesia in extraction of impacted mandibular third molars: a randomised controlled trial.

Aim To compare the anaesthetic effect of combination of inferior alveolar nerve block anaesthesia and local infiltration anaesthesia with nerve block anaesthesia techniques in the extraction of mandibular third molars.Materials and methods One hundred and fifty healthy adult volunteers were divided into three groups and were administered three different local anaesthetic techniques before tooth extractions: group A (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with lidocaine), group B (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with mepivacaine) and group C (inferior alveolar nerve block anaesthesia with lidocaine and infiltration anaesthesia with mepivacaine). The patients' reported pain on anaesthesia injection and tooth extraction, the surgeon's assessment of anaesthetic effect, the severity of intra-operative bleeding and post-operative complications were evaluated.Results There was no significant difference in visual analogue scale (VAS)-pain of anaesthesia among the three groups. Compared with groups A and B, group C had reduced VAS-pain of tooth extraction scores. Additionally, the surgeon's assessment of anaesthetic effect improved and intra-operative bleeding decreased.Conclusions The combination of inferior alveolar nerve block and infiltration anaesthesia provides a stronger anaesthetic effect in the extraction of mandibular third molars.

Assessment of the Need for Routine Distolingual Local Anesthetic Infiltration in Addition to Traditional Inferior Alveolar, Lingual and Long Buccal Nerve Blocks in Mandibular Third Molar Extractions.

Background and Objectives:Persistent pain during the removal of mandibular third molars is often due to accessory nerve supply causing inadequate local anesthesia. This study aims to assess the requirement of routine distolingual infiltration anesthesia in addition to traditional inferior alveolar, lingual, and long buccal nerve block in mandibular third molar extractions.Methodology:Sixty patients requiring mandibular third molar extraction were randomly divided into two equal groups; Group A (Classic inferior alveolar, lingual, and buccal nerve block) and Group B (with an additional 0.2 ml distolingual infiltration). During various steps of the procedure, any complaint of pain was recorded and graded on a subjective Visual Analog Scale (VAS).Results:There was no significant difference between the two groups in regard to age (P = 0.666) and sex (P = 0.432). And also, no difference was found in angulation (P = 0.757), class (P = 0.417) and position (P = 1.000) of third molars. Mean VAS scores in Group B (0.153) were significantly lower (P = 0.004) than that of Group A (0.600). VAS scores during procedural steps were significantly lower in Group B during mucoperiosteal elevation (P = 0.050), bone guttering (P = 0.037), and tooth splitting (P = 0.052).Conclusion:Routine distolingual infiltration anesthesia, in addition to classic inferior alveolar, lingual, and long buccal nerve block, is recommended for the extraction of mandibular third molars.

Efficacy of 2% Lignocaine and 4% Articaine in Oral Surgical Procedure: A Comparative Study

To compare the efficacy of 2% lignocaine and 4% articaine in the extraction of mandibular molars. This study was conducted on 120 patients requiring surgical removal of tooth. Patients were categorized into 2 groups with 60 samples each. Group I patients were administered 2% lignocaine with 1:50,000 epinephrine and group II patients were administered 4% articaine with 1:100,000 epinephrine for the extraction of mandibular molar. Inferior alveolar nerve, lingual, and buccal nerve block used in both groups to anesthetize the area. The mean onset of action in group I was 85.2 seconds and in group II was 52.6 seconds, duration of anesthesia in group I was 170.2 minutes and in group II was 226.8 minutes, duration of procedure was 30.4 minutes in group I and 32.6 minutes in group II, pain during procedure in group I was 2.75 and in group II was 1.42, pain after procedure was 1.41 in group I and 0.82 in group II, pain during anesthesia insertion was 1.52 in group I and 1.04 in group II. Forty-six (76.7%) patients in group I and 52 (86.7%) patients in group II did not require re-anesthesia, while 12 (20%) in group I and 8 (13.3%) in group II required 1 time re-anesthesia and 2 (3.3%) patients required 2 times re-anesthesia in group I. Articaine can be effectively used in oral surgical procedures as there is early onset of action, longer duration of anesthesia, and less need of re-anesthesia. Articaine is more effective compared to lignocaine, hence it can be recommended alternatively for tooth extraction and other oral surgical procedures.

A Simplified Single-Penetration Technique of IANB (MK Technique) for Mandibular Anesthesia.

Owing to the anatomical basis established on the detailed course, distribution and innervations of buccal nerve in the literature, we believe that an effective and extensive buccal nerve block could be achieved when the nerve is anesthetized proximal to its branching point which relates to anteromedial aspect of ramus (retromolar fossa). Though several techniques of inferior alveolar nerve block (IANB) including few single-penetration approaches were already well reviewed and practiced, pitfalls remained in terms of achieving adequate retromolar soft tissue anesthesia, as well as undermining the very importance of contacting the bone and the orientation of the bevel. We propose a simplified single-penetration technique aligning almost similar to conventional technique and its well-adopted landmarks, but still obviating the need for a separate penetration for long buccal nerve anesthesia. To study the efficacy of a simplified single-penetration technique for mandibular anesthesia. To study the adequacy of the simplified IANB technique in minimizing the number of penetrations required to achieve buccal nerve anesthesia decreasing patient's pain and discomfort when IANB is performed and the ease of adaptability across the operators. A 25-gauge 42-mm needle, local anesthesia with adrenaline-2% lignocaine HCl (1:80,000), 2.5-ml syringe, observation form. Study 1-A sample size of 120 cases, in oral surgery department of our college, with 60 patients in Group I (control) where patients received anesthesia through conventional IANB and 60 patients in Group II (experimental) where patients received anesthesia through simplified IANB. Both the groups are again subdivided into group A (single operator) and group B (multiple operators). Study 2-20 bilateral mandibular impacted third molar in oral surgery department of our college, with right side (control-conventional technique) and left side (experimental-simplified single-penetration technique). VAS data are recorded in the excel sheet. The success rate of the simplified technique is quite comparable to the conventional groups. The mean pain and discomfort score in simplified technique was 3.08 which is relatively lower when compared to mean value in conventional technique which was 6.88. The difference was statistically significant. Simplified technique minimizes the number of penetrations, which substantially decreases patient's pain and discomfort levels not only during injection, but also during surgical procedures on mandibular posterior region because of extensive and profound buccal nerve territorial anesthesia.

A comparative study between 0.5% centbucridine and 2% lignocaine with adrenaline (1:200,000) for bilateral extraction of mandibular premolar using nerve block anesthesia: a double blind randomized controlled clinical study

Background: The purpose of the study was to compare the efficacy of 0.5% centbucridine and 2% lignocaine with adrenaline (1:200,000).Methods: A clinical prospective, controlled, randomized, double blind group study was conducted on 22 patients referred for extraction of mandibular premolars, who were randomly assigned to 2 groups by the split mouth method. Before extraction of mandibular premolar, either 0.5% centbucridine or 2% lignocaine with 1:200,000 adrenaline were used for anesthesia. All the patients were given inferior alveolar, lingual, and long buccal nerve blocks. Pain on injection, onset of anesthesia, duration of anesthesia and changes in blood pressure and pulse rate were monitored and recorded.Results: In our study, statistically significant difference was found between the efficacy of agents as for time for onset of anesthesia, duration of action, and changes in blood pressure and pulse rate, but no statistically significant difference was found for pain on injection between two groups.Conclusions: The efficacy of centbucridine was found to be more as compared to lignocaine with adrenaline, in rapid onset of anesthesia, longer duration of action, and cardiovascular stability. There was no significant difference in the pain on injection for both centbucridine and lignocaine with adrenaline. Centbucridine can be used in medically compromised condition where adrenaline is contraindicated.