Inferior Alveolar Nerve Block Research Articles

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial.

The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB). In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05). Sixteen females and 16 males in the age range of 40 to 20years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05). Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 yearswithout changing vital signs. IRCT20220815055704N1.

Reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents: a systematic review and meta-analysis of effectiveness

BackgroundThe application of rubber dams is a widely accepted method of tooth isolation in dental practice. Placement of the rubber dam clamp might be associated with levels of pain and discomfort, especially in younger patients. The purpose of the present systematic review is to evaluate the efficacy of the methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents.Materials and methodsEnglish-language literature from inception until September 6th, 2022 was searched in MEDLINE (via PubMed), SCOPUS, Web of Science, Cochrane, EMBASE, and ProQuest Dissertations & Theses Database Global for articles. Randomized controlled trials (RCTs) comparing methods of reducing the pain and/or discomfort associated with rubber dam clamp placement in children and adolescents were retrieved. Risk of bias assessment was performed using a Cochrane risk of bias-2 (RoB-2) risk assessment tool and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence profile.Studies were summarized and pooled estimates of pain intensity scores and incidence of pain were calculated. The meta-analysis was conducted in the following groups according to type of interventions (LA, audiovisual (AV) distraction, behavior management (BM), electronic dental anesthesia (EDA), mandibular infiltration, inferior alveolar nerve block (IANB), TA), outcome (intensity or incidence of pain), and assessment tool (face – legs – activity – cry – consolability (FLACC), color scale, sounds – motor – ocular changes, and faces pain scale (FPS)):(a) pain intensity using (LA + AV) vs (LA + BM), (b) pain intensity using EDA vs LA (c) presence or absence of pain using EDA vs LA (d) presence or absence of pain using mandibular infiltration vs IANB (e) Comparing pain intensity using TA vs placebo (f) Presence or absence of pain using TA vs placebo.Meta-analysis was conducted using StataMP software, version 17.0 (StataCorp, College Station, Texas). Restricted maximum-likelihood random effect model (REML), Mean difference (MD) with 95% confidence interval, and log odds ratio (OR) with 95% CI were calculated were calculated.ResultsInitially, 1452 articles were retrieved. Sixteen RCTs were finally included for reviewing and summarizing. Nine articles with a total of 867 patients were included for quantitative meta-analysis. The differences in pain intensity scores were not significant in any comparison groups (group a: [MD = -0.04 (95% CI = − 0.56, 0.47), P = 0.87, I2 = 0.00%], group b: [MD = 0.25 (95% CI = -0.08, 0.58), P = 0.14, I2 = 0.00%], group c [MD = -0.48 (95% CI = -1.41, 0.45), P = 0.31, I 2 = 0.00%], group d: [MD = -0.67 (95% CI = -3.17, 1.83), P = 0.60, I 2 = 0.00%], group e: [MD = -0.46 (95% CI = -l.08, 0.15), P = 0.14, I 2 = 90.67%], and group f: [MD = 0.61 (95% CI = -0.01, 1.23), P = 0.06, I 2 = 41.20%]. Eight studies were judged as having some concern for risk of bias and the remaining studies were considered as low risk for bias. The certainty of evidence was considered medium for all comparison groups.DiscussionIn the present meta-analysis, a considerable difference was obtained between the included studies regarding intervention methods and pain assessment tools and the analysis was performed in groups with small numbers of the studies. Owing to the mentioned variabilities and the small number of studies, the results of the analysis should be interpreted with caution. The indistinguishability of the manifestations of pain/discomfort from fear/anxiety, particularly in children, should also be considered while using the results of the present study.Within the limitations of the current study, no significant differences were found between the proposed methods for reducing pain and discomfort associated with rubber dam clamp placement in children and adolescents. A larger number of more homogenous studies regarding intervention methods and pain assessment tools need to be conducted in order to draw stronger conclusions.Trial registrationThis study was registered in PROSPERO (ID number: CRD42021274835) and research deputy of Mashhad University of Medical Sciences with ID number 4000838 (https://research.mums.ac.ir/).

Cryotherapy and pain intensity during endodontic treatment of mandibular first permanent molars with symptomatic irreversible pulpitis: A randomized controlled trial

ObjectivesThe study aimed to assess the effectiveness of cryotherapy application after inferior alveolar nerve block (IANB) administration of the mandibular first permanent molars with symptomatic irreversible pulpitis (SIP) in adolescence. The secondary outcome was to compare the need for supplemental intraligamentary injection (ILI).Materials and methodsThe study was designed as a randomized clinical trial including 152 participants aged from 10 to 17 years who were randomly assigned to two equal groups; cryotherapy plus IANB (intervention group) and the control group (conventional INAB). Both groups received 3.6 mL of 4% articaine. For the intervention group, ice packs were applied in the buccal vestibule of the mandibular first permanent molar for 5 min. Endodontic procedures started after 20 min for efficiently anesthetized teeth. The intraoperative pain intensity was measured using the visual analogue scale (VAS). The Mann–Whitney (U) and chi-square tests were applied to analyze data. The significance level was set to 0.05.ResultsThere was a significant reduction in the overall intraoperative VAS mean in the cryotherapy group compared to that in the control group (p = 0.004). The success rate was significantly higher in the cryotherapy group (59.2%) compared to the control group (40.8%). The frequency of extra ILI was 50% and 67.1% in the cryotherapy and control groups, respectively (p = 0.032).ConclusionsThe cryotherapy application boosted the efficacy of pulpal anesthesia of the mandibular first permanent molars with SIP in patients below the age of 18 years. Additional anesthesia was still necessary for optimal control over pain.Clinical relevancePain control during endodontic treatment of primary molars with irreversible pulpitis (IP) is a significant factor in a child’s behavior in the dental office. Although the inferior alveolar nerve block (IANB) is the most commonly used technique to anaesthetize mandibular dentition, we found its success rate to be relatively low during endodontic treatment of primary molars with IP. Cryotherapy is a new approach that significantly improves the efficacy of IANB.Clinical trial registrationThe trial was registered at ClinicalTrials.gov (reference no. NCT05267847).

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.

Comparing intraosseous computerized anaesthesia with inferior alveolar nerve block in the treatment of symptomatic irreversible pulpitis: A randomized controlled trial.

The aim of this study was to compare the cardiovascular effects [heart rate, oxygen saturation (SpO2 ), systolic and diastolic blood pressure] and the anaesthetic efficacy of intraosseous computerized anaesthesia (ICA) versus inferior alveolar nerve block (IANB) in Symptomatic irreversible pulpitis (SIP). The study protocol was registered with ClinicalTrials.gov (NCT03802305). In a randomized, prospective clinical trial, 72 mandibular molar teeth with SIP were randomly allocated to conventional IANB injection (n = 36) or ICA injection (n = 36), both with 1.8 mL of 4% articaine with 1:100 000 epinephrine. The primary objective was to assess the cardiovascular parameters (heart rate, oxygen saturation, blood pressure) before, during and after the anaesthesia. The secondary objectives were to compare ICA with IANB for success and postoperative outcomes for up to 3 days. The maximum increase in heart rate in the ICA group was greater than in the IANB. Other cardiovascular parameters did not show differences throughout the clinical procedure. There were no statistically significant differences (p > .05) between groups for sex, age, or anxiety. The total success rate of ICA (91.43%) was significantly higher (p = .0034) than that of IANB (69.44%). This study establishes that ICA is safe and efficient in the first intention for the treatment of SIP of the mandibular molar.

Efficacy of inferior alveolar nerve block and intraligamentary anesthesia in the extraction of primary mandibular molars: A randomized controlled clinical trial

ObjectiveThe study aims to compare the effectiveness and quality of intraligamentary anesthesia (ILA) and inferior alveolar nerve block (IANB) for primary mandibular molar extraction. MethodsThis prospective, randomized clinical study included patients aged 5 to 13 years scheduled for primary mandibular molar extraction. A total of 208 participants were randomly allocated into two groups (n = 104 each group), IANB and ILA, who were administered 2% lignocaine with epinephrine 1:100,000. Patients rated their pain during injection and extraction (VAS pain score). Frankl’s behavior rating score, quality of anesthesia as perceived by clinician, and duration of procedure were recorded. Demographic and other variables were analysed using Pearson x2 test, Pearson correlation coefficient, Fisher exact test, or an analysis of variance, as appropriate. ResultsIn patients who received IANB, the clinician reported a slightly better quality of anesthesia (p = 0.19) than those who received ILA (VAS score 1.3 ± 0.7 Vs 1.6 ± 0.4). Mean (±SD) score for pain during extraction were found be 1.7 (±0.6) for the IANB group and 1.8 (±0.5) for the ILA group. The clinician observed 46.2% of patients in the IANB group and 39.4% of patients in the ILA group had no discomfort during extraction. Frankl’s behavior score was negatively correlated with the quality of anesthesia and the time taken to complete the extraction (p = 0.017 and p = 0.053, respectively). ConclusionThe efficacy of conventional ILA was similar to IANB, and thus ILA might be a good alternative to the IANB while extracting primary mandibular molars.

Comparative evaluation of anaesthetic potency of 0.5 % Levobupivacaine and 0.5% Ropivacaine in Inferior alveolar nerve block among patients undergoing lower impacted third molar surgery.

Comparative evaluation of anaesthetic potency of 0.5 % Levobupivacaine and 0.5% Ropivacaine in Inferior alveolar nerve block among patients undergoing lower impacted third molar surgery.

Comparative evaluation of anaesthetic potency of 0.5 % Levobupivacaine and 0.5% Ropivacaine in Inferior alveolar nerve block among patients undergoing lower impacted third molar surgery.

Comparative evaluation of anaesthetic potency of 0.5 % Levobupivacaine and 0.5% Ropivacaine in Inferior alveolar nerve block among patients undergoing lower impacted third molar surgery.

Efficacy of Bupivacaine Inferior Alveolar Nerve Block Versus Intravenous Use of Tramadol for Postoperative Pain Control in Mandibular Parasymphysis Fractures

Background: One of the most crucial parts of any operation is postoperative monitoring and management. Numerous clinical strategies for administering analgesic drugs have been developed to reduce postoperative pain in patients. High opioid doses before, during, and after surgery might cause respiratory depression, sleepiness, nausea, vomiting, itching, difficulties urinating, and ileus. Most surgeries cause maxillo-mandibular fixation (locked jaw). In the early postoperative period, ventilatory depression and vomiting are common that’s why this study focuses on the two types of drug intervention and measures the effects. Objective: To evaluate the efficacy of bupivacaine inferior alveolar nerve block vs intra-venous tramadol (opioid) in postoperative pain control. Study Design: Prospective, randomized control trial Study Setting: The study was conducted in Jinnah Hospital, Lahore from 6 April 2022 to 6 October 2022. Methodology: The non-probability sampling technique was used to recruit the patients. Patient aged between 18 – 40 years with simple mandibular parasymphyis fracture was included in the study. However, patients with diabetes, ischemic heart disease &amp; bone diseases were excluded from the study. The patients were divided into two groups. One group received bupivacaine while the other group received tramadol (opioid). The pain of the patient was calculated using the Visual Analog Scoring system. The frequency of pain was recorded postoperatively between 0-3hrs, 3-6hrs, 6-12hrs, and 12-24hrs. The data were analyzed by using SPSS version 22. Results: Fifty-two patients were recruited in this trial and randomly assigned to the bupivacaine group and tramadol group, there were no significant differences between the two groups in terms of demographic data including age, gender, BMI and mean operation time (P&gt;0.05) as shown in table 1. The Visual Analog and Category Pain Scale (VAS) significanlty reduced in both the groups. The more decline in pain was observed from 12hrs to 24hrs in bupivacaine group from 4.46±0.64 to 2.27±1.00 respectively. In addition, a repeated-measures ANOVA was utilized to evaluate the VAS ratings between the two groups, revealing that the VAS values in the bupivacaine group were considerably lower than those in the tramadol group 16 and 24 hours after surgery (P=0.001 and P=0.000, respectively). Practical implication: The study's justification is the dearth of local or regional information on this topic. Therefore, the objective of this research was to evaluate the effectiveness of tramadol intravenously against bupivacaine inferior alveolar nerve block for postoperative pain control in mandibular parasymphysis fractures. Conclusion: In conclusion, 2mL.5% Injection Bupivacaine (1:200000) administered at the fracture site in the mandibular parasymphysis fractures area post-operation relieved somatic wound pain better than tramadol without major side effects. Thus, local infiltration of bupivacaine over the section incision is recommended for safe and efficient post-operative pain. Keywords: Bupivacaine, Tramadol, Mandibular Parasymphysis Fractures, Alveolar Nerve Block

Effectiveness of buffered and non-buffered local anaesthetic in inferior alveolar nerve block: a randomised study

The objective of this study was to compare the effectiveness of buffered and non-buffered local anaesthetic (LA) following inferior alveolar nerve block (IANB). This study was conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto from June 2020 to January 2021. Subjects were randomised into Groups A and B. Group A received 2 ml of freshly prepared 2% lignocaine with 1:100,000 adrenaline buffered with 0.18 ml of 8.4% sodium bicarbonate solution while those in Group B received non-buffered 2% lignocaine with 1:100,000 adrenaline LA solutions. The onset of action of the LA was assessed by subjective and objective methods, while pain at the injection site was assessed using a numerical rating scale. Data obtained were analysed using statistical package for social sciences (IBM SPSS) version 21. The mean (SD) ages for Groups A and B were 37.4 (14.9) and 40.1 (14.4) years, respectively. The mean (SD) onset times of the LA by subjective testing were 126 (31.7) and 201 (66.8) seconds for Groups A and B, respectively. Similarly, the mean (SD) onset times of the local anaesthesia by objective testing for Groups A and B were 186 (41.0) and 287 (85.0) seconds, respectively, and both were significant (p<0.001). Pain at the injection site assessed objectively and subjectively were also statistically different (p<0.001). The findings of this study suggest that buffered LA is more effective than non-buffered LA of the same composition when used for IANB particularly concerning a significantly faster rate of onset and less pain at the injection site.

Evaluation of a Nishit-Rama Modification of a Gow-Gates Technique for Giving Mandibular Nerve Block: A Randomized Controlled Trial.

In pursuit of improving currently available anesthetic techniques for dental procedures, present study evaluated a novel mandibular nerve block technique in comparison with control group administered standard inferior alveolar nerve block (IANB) technique. A randomized, comparative, parallel design, double-blind study was conducted at Tata Main Hospital, Jamshedpur, India which enrolled 140 adult patients (70 in experimental group and 70 in control group) requiring minor surgical dental procedures involving normal forceps method extractions of mandibular molars. Tingling or numbness of the lower lip of the same side was considered suggestive of successful IANB blockage. Onset of anesthesia, aspiration of blood and failure of anesthesia were also assessed and compared between study groups. Mean age and gender distribution were statistically comparable between study groups (p > 0.05). Diagnosis of the enrolled cases was either acute or chronic apical periodontitis, which was distributed similarly in study groups (p > 0.05). Mean time to onset of the IANB blockage was found to be significantly longer in experimental group versus control (3.72 ± 0.84 versus 1.93 ± 0.62min, p < 0.05). Both, number of positive aspirations (7.14% versus 25.72%, p < 0.05) and need for additional injection were significantly lower in experimental group (18.58% versus 74.28%, p < 0.05). Incidence of pain while tooth removal was similar between study groups (p > 0.05). The novel technique for mandibular nerve block evaluated in present study has various advantages like avoidance of technical difficulties with absence of extra-oral landmark, lower chances of reinsertion reducing complication risk, and decreased systemic complications, evident by lower rates of aspirations.

Topographic analysis of mandibular ramus zone and anesthetic technique optimizing device

This is a study on the topographic relationship between the final extremity of the lingula of the mandible and the anterior and posterior borders of the ramus of the mandible. This work proposes the creation of a device which directs the positioning of the syringe cartridge + needle assembly, optimizing the execution of the anesthetic technique for blocking the inferior alveolar nerve. Thirty macerated adult mandibles were used, in which two measurements were obtained with the aid of a digital caliper: 1- distance between the anterior border of the mandibular ramus and the final extremity of the lingula; 2- distance between the final extremity of the lingula and the posterior border of the mandibular ramus. Photographs of the mandibles were analyzed on a computer, calculating the angle formed between three points: (1) the anterior border of the mandibular ramus – A point; (2) the anterior point between the inferior premolars of the opposite antimere – P point and (3) the final extremity of the lingula – L point. For the right antimere, 33.33% of the angles found were within the range of 6°-7°, and 23.33% between 9°-10°. As for the left, 30.00% were in the range between 5°-6°, and 23.33% between 7°-8°. It can be concluded that in more than 50% of the analyses, the formed angle varies predominantly between 5° and 10°, therefore, the proposed device will be able to minimize the chances of technical errors and optimize the success for the inferior alveolar nerve block.

To Compare the Effectiveness of Complementary Therapies on Pain Perception to Intra-Oral Needle Insertion in Pediatric Patients – A Randomized Clinical Trial

Background: Recently, effective control of pain has shifted to other techniques like psychological, complementary, and alternative methods which have gained popularity in the contemporary world. However, the scientific validity of such alternative approaches is often questioned. Objective: To compare the effectiveness of Complementary therapies on pain perception to intraoral needle insertion in paediatric patients. Methodology: A Randomized clinical trial was conducted on 78 children aged 8-12 years visiting the department after obtaining informed consent from parents. Children were divided into 3 groups i.e., Group A- acupressure, Group B –aromatherapy, and Group C- control group. Every child was recalled for 3 appointments and in each appointment, any therapy was performed randomly before giving an inferior alveolar nerve block. Pain perception was evaluated using Wong-Baker Faces Scale and the Sound eye motor scale. The intergroup comparison was statistically analyzed using the ANOVA test and distribution using the chi-square test. Result Synthesis: On intergroup comparison of Wong-Baker and SEM scale between the acupressure and aromatherapy group, a statistically significant difference was seen, whereas when acupressure and aromatherapy were compared with the placebo group highly significant difference was seen (p=0.00). Conclusion: Acupressure and aromatherapy can be used as an adjunct to significantly reduce the pain perception of children undergoing intraoral needle insertion.

Effect of Vocal Anesthesia on Adult Dental Patients during Covid-19 pandemic period

BACKGROUND: Pain is as a major concern with dental patients. The dentist-patient interaction can reveal the presence of anxiety and fear, which may result in rise of pain. This study aimed to assess vocabulary communication as support to dental anesthesia on the adult dental patient.MATERIALS AND METHODS: This is a prospective, randomized clinical study, conducted from February 2020 through March 2021. Two hundred individuals (112 males, 88 females) of the age range (16 to 84 years) were separated into two groups for testing the level of pain during dental local anesthesia, with vocal communication and without vocal communication.RESULTS: While the control group showed no difference between males and females, there was a difference between the sexes in the experimental group with past dental visits, VAS and injection type having less anxiety (p=0.0001) while with education/VAS having (p£0.01) as appear in sex to age (p£0.05). There was no difference when data were compared by age, or type of anesthesia (inferior alveolar nerve block or infiltration technique).CONCLUSION: Dental anxiety can be alleviated by talking to the patients before the procedure, which could reduce the amount of pain.

Needle Fracture in Pterygomandibular Space during Loco-Regional Dental Anesthesia: Systematic Review

Background: Dentists administer hundreds of thousands of injections every day without particular concern, but the administration of local anesthetics can cause problems. One event, fortunately uncommon, that is discussed accurately but can cause significant concern is needle breakage. The purpose of this article is to review what has been reported in the literature on this topic to learn about patient symptomatology, management and possible complications. In addition, the case of a 34-year-old patient with needle persistence in the pterygoid space due to accidental rupture during inferior alveolar nerve block (IAN) was reported, for whom non-removal and monitoring over time was chosen. Materials and Methods: A literature search of the PubMed, Scopus, Web of Science and ScienceDirect databases was conducted analyzing anesthetic needle rupture during dental surgery. Results: At the end of the selection process, 17 articles resulted. Asymptomatic subjects were found, as well as those who had several symptoms. No issues were recorded by any of the authors, whether they withdrew the needle or simply monitored the patient. Conclusions: The literature on needle rupture during dental local anesthesia is scarce, and studies report conflicting results on treatment options. Most authors reported removing the fragment; however, others preferred conservative management limited to patient monitoring. No complications were reported in any study.

Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review.

The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial.

A comparative evaluation of children's anxiety with the use of nitrous oxide-oxygen (N2O-O2) inhalation sedation during the administration of inferior alveolar nerve block (IANB). A total of 60 children between 3 and 12 years of age, with Frankl's behavior rating of 2-3 requiring IANB for any dental procedure were enrolled in this randomized clinical study. Group I (n = 30) received N2O and oxygen inhalation sedation at a concentration in the range of 25-50%, whereas group II (n = 30) received 100% O2 as a placebo. The physiological parameters like pulse rate, respiration, blood pressure, and O2 saturation were measured at the baseline, intraoperatively [during and after administration of local anesthesia (LA)] and postoperatively after the termination of the gases in both groups. The sedation level was measured intraoperatively (before administration of LA) using the Ramsay Sedation Score (RSS). The discomfort and anxiety were measured at the baseline, intraoperatively, and postoperatively using the Face, Legs, Activity, Cry, Consolability (FLACC) behavior scale. The data were evaluated using the statistical software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics 20.0. There was a significant difference in the FLACC scores between the two groups, intraoperatively (p-value-0.002), and postoperatively (p-value-0.049). The mean of the RSS for group I was 2.80 + 1.03, and for group II was 1.80 + 0.81. All the physiological parameters recorded were within the normal range. The use of N2O-O2 inhalation improved the anxiety levels in children while receiving the IANB and showed significant anxiolytic and sedative effects as compared to O2 inhalation. Nitrous oxide-oxygen (N2O-O2) inhalation can be used as a nonpharmacological behavior management adjunct for invasive treatments for children with utmost comfort for the child. Thomas PS, Dave BH, Shah DJ, et al. Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(1):30-36.

Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial.

The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney U test, independent T-test, and Fisher's exact χ 2 test were performed for statistical analysis (α = 0.05). This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1.

Analysis of Hemodynamic Changes after Administration of Mepivacaine HCL 3% with Prilocaine 3% Solution + Felypressin

Introduction: With regards to the usage of local anesthetic drugs in hypertensive patients, this study is designed for comparing the effects of mepivacaine 3% and prilocaine 3% + felypressin in hemodynamic changes after inferior alveolar nerve block to help dental practitioner select anesthetic solutions for hypertensive patients considering their hemodynamic effects in order to provide patient safety.Materials &amp; Methods: In this double blind clinical trial 32 patients were referred to oral and maxillofacial surgery department of Shiraz dentistry school in 2021 were divided into 2 groups with 16 patients in each group. In first group, inferior alveolar nerve block was accomplished by mepivacaine 3% and in the other group, prilocaine 3% and felypressin. Then systolic and diastolic blood pressure, heart rate and oxygen saturation were measured at 4 different time points consisting of before injection, immediately after injection, 10 minutes after injection and 30 minutes after tooth extraction. The data were analyzed by ANOVA and T-test (p value &lt; 0.05).Results: There were no statistically significant differences in systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation changes between mepivacaine and prilocaine groups during all four sampling time points. But in each group, individually there were significant differences in systolic and diastolic blood pressure, heart rate and oxygen saturation in different times. In addition mepivacaine causes a significant increase in systolic blood pressure immediately after injection but in contrast prilocaine + felypressin didn’t do so.Conclusion: We recommend prilocaine + felypressin in comparison with mepivacaine for local anesthesia in hypertensive patients.

Effect of the inferior alveolar nerve block injection versus maxillary infiltration with two local anesthetic agents on cardiovascular parameters: A randomized comparative double-blind clinical trial

Abstract This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection. The mean diastolic blood pressure showed a greater reduction following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The mean HR showed a significantly greater increase following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The effect of type of anesthetic agent on diastolic blood pressure depended on the type of injection (p=0.033). Administration of 2% lidocaine with 1:80.000 epinephrine, in comparison to prilocaine with felypressin, can cause changes in cardiovascular parameters such as heart rate and diastolic blood pressure in patients undergoing restoration of a maxillary or mandibular molar tooth. Type of injection has no significant effect on cardiovascular parameters.