Inferior Alveolar Nerve Block Research Articles

Accuracy of Mandibular Foramen Localization Using Digital Orthopantomogram (OPG) in Middle Eastern Population

Background/Objectives: Locating the mandibular foramen (MF) through imaging is clinically important for inferior alveolar nerve (IAN) anesthesia and mandibular ramus osteotomies. Although cone-beam computed tomography (CBCT) is superior in imaging the mandible, an orthopantomogram (OPG) is preferred for its ease of use and availability. Therefore, the present study aimed to evaluate the accuracy of digital OPG in localizing the MF, in a subset of the Middle Eastern population. Methods: Radiographic images (OPG and CBCT) of selected patients (adults, dentulous and no mandibular abnormalities) were used to locate the MF through digital measurements (mm) of the anteroposterior distance from the anterior border of the ramus (MF-AP) and the superoinferior position from the mandibular occlusal plane (MF-SI). Measurements were statistically compared between OPG and CBCT for accuracy. Differences in measurements between OPG and CBCT were compared against the anatomic location (right/left), age and biological sex, assuming a p-value < 0.05 as significant. Results: A total of 204 radiographic records (males: 100/females: 104/mean age: 34.65 ± 11.55 years) were evaluated. The measurements for the MF were MF-AP-OPG (right: 13.53 ± 2.44/left: 13.19 ± 2.25), MF-AP-CBCT (right: 13.61 ± 2.39/left: 13.36 ± 2.19), MF-SI-OPG (right: 5.25 ± 1.71/left: 5.41 ± 1.65) and MF-SI-CBCT (right: 5.59 ± 1.66/left: 5.52 ± 1.61). Measurements between OPG and CBCT were not significantly different, except for MF-SI (right) (p = 0.042). While the overall difference between OPG and CBCT (MF-AP/MF-SI) measurements showed a significant association (p < 0.01) with the anatomic location (right/left), a significant association (p < 0.05) with biological sex was observed only for MF-AP. Conclusions: Based on this study’s outcomes, digital OPG is an accurate modality to locate the MF based on anteroposterior (MF-AP) and superoinferior (MF-SI) measurements. This would be clinically beneficial for dental and oral surgeons to achieve the optimum IAN block anesthesia based on preoperative panoramic radiographs. Similarly, it would assist maxillofacial surgeons in planning mandibular orthognathic surgeries and ramus osteotomies without complications.

Can computerized intraosseous anaesthesia replaces the inferior alveolar nerve block in children? A randomized controlled clinical trial

Can computerized intraosseous anaesthesia replaces the inferior alveolar nerve block in children? A randomized controlled clinical trial

Comprehensive Survey on the Performance of Lignocaine in Root Canal Treatment

Objective: The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy. Methods: A survey-based approach was utilized to gather data from clinicians on their experiences with lignocaine in endodontic procedures. The study assessed the success rates of various techniques, including the inferior alveolar nerve block (IANB), intraligamentary, and intraosseous injections. The impact of different adrenaline ratios (1:100,000, 1:80,000, and 1:200,000) on anesthesia duration and effectiveness was also analyzed. Results: Lignocaine with 1:100,000 adrenaline was effective in the majority of cases, with IANB being the primary technique used for lower Lignocaine was identified as the anesthetic of choice by the majority of participants, preferred for its rapid onset and adequate duration of action. Most clinicians reported that lignocaine provided effective anesthesia for routine root canal procedures when inflammation was present or additional duration was required, clinicians recommended using supplemental techniques such as intraligamentary and intraosseous. Alternative anesthetics like articaine and bupivacaine were used successfully in patients with lignocaine allergies. Conclusion: Lignocaine remains a reliable anesthetic for root canal treatments, particularly in the lower jaw, when used with appropriate techniques and adrenaline ratios. However, challenges such as inflamed tissues and patient allergies require alternative strategies, including supplemental injection techniques and the use of different anesthetic agents. Clinicians should be adaptable in their approach to ensure effective anesthesia and patient safety. The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy.

Analgesic effect of ultrasound-guided extraoral mandibular nerve block compared to intraoral conductive block of the inferior alveolar nerve after lower third molar alveolectomy: a clinical prospective study

BackgroundThe analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block.MethodsThirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic.ResultsThe US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia.ConclusionUS-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT06009302, identification number: NCT06009302, date of registration: 18/08/2023.

Efficacy of QuickSleeper Intraosseous Injection of 4% Articaine in Mandibular First Molars With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

Objective To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP). Methods Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed. Results The success rates were 40.6% for IANB and 81.2% for IO (P &lt; .001). IO exhibited a significantly lower injection pain (P = .027), a shorter onset of action (P &lt; .001), a greater heart rate increase (P &lt; .001), a faster heart rate recovery time (P &lt; .001), and a shorter duration of action (P &lt; .001) vs IANB. Conclusion Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia.

Overcoming local anesthesia failure during routine dental treatments in children.

Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts. To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children. We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system. The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA. The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system.

Comparative Analysis of Different Variables on Complications of Local Anesthesia in Dentistry

Background: With continuous progress in medicine and treatments, anesthetists will more often have to treat risk patients in dental surgeries. Therefore there is a need to compare the rate of incidence of complications with risk factors so we can minimize the drug-related complications in patients undergoing dental anesthesia. The study aimed was to evaluate the incidence rate of local anesthetic complications in dentistry and also to analyze the effect of different risk factors on the incidence of local anesthetic complications. Methods: It was an observational cross-sectional study conducted at the Maxillofacial Department in Sardar Begum Dental College and Hospital. Once the patient signed a consent form, Performa was used to collect patient data. The patients were given lidocaine 2% with 1:100,000 epinephrine by either infiltration or inferior alveolar nerve block (IANB) injection or by both techniques to induce anesthesia, then underwent different dental procedures. We focused on six complications and six different risk factors regarding the total population in our study Performa. Results: Our study included 207 dental patients in total, of which 45% were men and 55% were women. The overall complications observed during the study were 11.5% of patients receiving dental local anesthesia in which non-risk factor patients were 6.7% and risk factor patients were 4.8%. Conclusion: The current study reports a high incidence of dental local anesthetic complications, including bleeding, tachycardia, and salivation. In addition, this study also reports the high incidence of bleeding and tachycardia in diabetic and hypertensive patients. Hence study recommends that dentists should take medical history before each procedure to reduce risk of complications associated with dental anesthesia.

A new and simplified extraoral approach for inferior alveolar nerve block: a cadaveric study and clinical case reports.

Inferior alveolar nerve (IAN) and lingual nerve (LN) blocks are commonly performed using the intraoral landmark techniques. However, these methods have a risk of unanticipated nerve and arterial injury or a higher failure rate. We developed a novel extraoral approach for the IAN and LN blocks, the "inferior alveolar nerve block mandibular angle approach (IANB-MA)," using ultrasound guidance. The mechanism of action of this nerve block was examined anatomically, and its clinical feasibility was reported. We performed the IANB-MA on four cadavers using different dye volumes (2, 4, 6 and 8mL). The ultrasound probe was placed on the lower edge of the mandibula of each cadaver, and the needle was advanced to the mandibular inner surface. Blue acrylic paint solution was injected, and its spread was evaluated by dissection. Our study showed that the medial pterygoid muscle fascia was stained in all cadavers. The dye reached the LN consistently, and the IAN was stained with higher volumes (6mL and 8mL). The pterygomandibular space was filled with 6mL and 8mL of the dye. The IANB-MA successfully reduced pain in three patients with trigeminal neuralgia, tongue or jaw pain. The IANB-MA is a novel ultrasound-guided approach to the IAN and the LN. The clinical feasibility and effectiveness of this technique were confirmed in our patients. It may be a good alternative analgesic approach to other conventional approaches.

Comparative Evaluation of Endo Ice® Refrigerant Spray, Endo Frost® Refrigerant Spray and Topical Anesthetic Agent Precaine B® on the Pain Perception in Children Prior to Administration of Local Anaesthesia – An Invivo Study

To compare and evaluate the efficacy of Endo Ice® refrigerant spray, Endo Frost® refrigerant spray and topical anaesthetic agent Precaine B® on the pain perception during local anaesthesia administration in pediatric dental patients.  Material and methods: A total of 87 participants in the age group of 6-12 years were divided into 3 groups randomly with 29 in each group. The cotton applicator sprayed with Endo Ice was held in contact with the buccal mucosa for 10 seconds. Immediately after the removal of the cotton applicator, inferior alveolar nerve block was administered. Similarly, Endo Frost was used on the participants. 0.1 mg of Precaine B was applied over the injection site contacting the buccal mucosa using sterile cotton applicator. FLACC evaluation was done by one trained personnel during the local anaesthesia administration. Following the local anesthesia, the participants were asked to rate their pain experience using VAS.  Results: The mean score of the Endo ice, Endo frost, and Precaine B were 4.3793, 4.4828 and 5.5517 respectively using the FLACC scale. The mean score of the Endo ice, Endo frost, and Precaine B were 4.2069, 4.2069 and 4.931 respectively using the VAS scale. Greater reduction in pain perception were observed in Endo Ice group followed by Endo Frost group and Precaine group. It was not statistically significant (p&lt;0.005).  Conclusion: Endo ice, Endo frost and Precaine B were effective in reducing the pain perception in children, thereby reducing their fear and anxiety. Endo Ice group showed greater reduction in pain perception and higher efficacy than other groups, even though the results were not statististically significant.

Breaking Barriers in Paediatric Pain Management: Combined Cryotherapy and Vibration Therapy Vs. Audio-visual Aids for Alleviating Discomfort during Inferior Alveolar Nerve Block Administration in Children - a Randomized Controlled Study

Breaking Barriers in Paediatric Pain Management: Combined Cryotherapy and Vibration Therapy Vs. Audio-visual Aids for Alleviating Discomfort during Inferior Alveolar Nerve Block Administration in Children - a Randomized Controlled Study

Comparison of Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Periodontal Flap Surgery in the Mandible

Abstract Introduction: The efficacy of infiltration versus inferior alveolar nerve block (IANB) injection techniques during periodontal flap surgery in the mandible is crucial for optimising patient care. This comparative study aims to evaluate the pain management, ease of administration and clinical outcomes associated with both anaesthetic methods. Infiltration anaesthesia involves localised administration, targeting specific sites, whereas IANB provides a broader anaesthetic effect by numbing the entire mandibular nerve. Understanding the advantages and limitations of each technique will enhance procedural efficiency and patient comfort. This research contributes valuable insights into best practices for periodontal surgeries. Materials and Methods: Twenty-five subjects who required periodontal flap surgery were included in the study to treat chronic periodontitis in the mandibular jaw. The surgery was performed under local infiltration of an anaesthetic agent on one side of the jaw and by an IANB on the other side. Pain perception was evaluated using the Visual Analogue Scale (VAS) score at various intervals during periodontal flap surgery. The effect of anaesthesia between the two techniques was compared and evaluated by analysis of variance using IBM Corp. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows [Version 25]. Armonk, New York, USA. IBM Corp; 2017. Results: Analysis determined the onset, duration and termination of anaesthesia induced by infiltration and the IANB technique. The onset and duration of anaesthesia by both techniques were comparable. The pain perception evaluated using the VAS score while using both anaesthesia techniques was also comparable. Conclusion: Infiltration anaesthesia can be used as an alternative to overcome the disadvantages and complications of IANB for periodontal surgery in the mandibular jaw.

Can postanesthetic cold sensibility test be used as a tool for the efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis of mandibular molars? – In vivo study

Objectives: The goal of this investigation was to determine the efficiency of a postanesthetic cold test for the detection of pulpal anesthesia to improve diagnostic accuracy. Materials and Methods: Fifty-two participants who showed symptomatic irreversible pulpitis on the mandibular first molar, aged from 18 to 65 years, were given inferior alveolar nerve block (IANB), and subjective anesthetic symptoms were seen after 15 min and were finally assigned for studies. To determine the effectiveness of a postanesthetic cold test for the detection of pulpal anesthesia, the target tooth was separated and Endo-Frost was utilized to conduct a postanesthetic cold sensibility test and was compared to the gold standard test, painful or painless sensation during actual root canal therapy. Of 52 participants, 9 had a positive response to the postanesthetic cold test and 43 had a negative response; 10 responded positively to the gold standard test, whereas 42 gave negative results. Results: The postanesthetic cold sensibility test can diagnose the effectiveness of pulp anesthesia showing a sensitivity of 80%, specificity of 97.62%, positive likelihood ratio of 33.6, negative likelihood ratio of 0.2, positive predictive value of 88.89%, negative predictive value of 95.35%, accuracy of 94.23%, and Youden’s index of 0.78. Conclusions: The postanesthetic cold sensibility test can be used as a tool for the efficiency of IANB before starting root canal therapy to minimize pain and anxiety in patients.

Influence of needle gauge on pain perception and use of obturators in achieving profound pulpal anesthesia - A double-blinded in vivo study.

Achieving profound pupal anesthesia and pain management is key in endodontic practice. However, inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia, during symptomatic irreversible pulpitis and has a high failure rate between 35% and 45%. Intrapulpal (IP) injection has been found to have increased efficiency and pain. The study aims to find the pain perception of 26G and 31G and the use of obturators in improving the efficacy of IP anesthesia. Eighty patients with symptomatic irreversible pulpitis after the failure of IANB were recruited and divided into four groups to receive IP with Group I A: 26G with obturators, Group I B: 26G without obturators, Group IIA: 31G with obturators, and Group IIB: 31G without obturators. The pain was measured using the visual analog scale and the effectivity of anesthetic injection by the duration of action. A 31G needle produced the least pain perception compared to the 26G needle during IP injection. A 31G with an obturator was the most efficient, acting in less than a minute and 26G without an obturator showed the least. Within the limitation of this trial, it can be concluded that lesser gauge needles reduce pain perception during IP, and obturators achieve adequate back pressure.

Determination of Location of Mandibular Foramen of Sri Lankans with Reference to Nearer Anatomic Landmarks by using Dry Mandibles

Objective: The mandibular foramen serves as a reference point in the inferior alveolar nerve block and is at risk in some maxillofacial surgeries. Therefore, it is crucial to localize the position of the mandibular foramen. Worldwide many studies have been conducted regarding this but in Sri Lanka, there aren’t any recorded studies. The objective of this study was to determine the location of the mandibular foramen with reference to nearer anatomical landmarks of the Sri Lankans according to gender.Methods: A total of 20 dry mandibles collected from the Department of Anatomy, Faculty of Medicine, Wayamba University Sri Lanka were included in this study. The distances from the mandibular foramen to 8 bony landmarks were measured using the digital vernier caliper. The data were analyzed using SPSS 23.0 Version. The mean distances were calculated and compared according to gender using the independent samples t-test. The differences in mean measurements between the right and left sides of the mandibles were compared according to gender using the paired samples t-test.Results: There was a significant difference between male and female mandibles in mean distances from the posterior border of the mandibular ramus on the left side, and from the angle of the mandible bilaterally. There was no statistically significant difference between any of the measurements of the right and left sides of the male mandibles, but there was a statistically significant difference in some of the measurements between the right and left sides of the female mandibles. Out of the 40 mandibular foramina observed, there was only one accessory mandibular foramen.Conclusions: According to the study it was proven that there’s a difference in the location of mandibular foramen according to gender. The location of the mandibular foramen in the Sri Lankan population was different from the documented locations of the mandibular foramen of various populations around the globe.

EVALUATION OF THE RELATIVE POSITION OF THE MANDIBULAR FORAMEN IN YEMENI CHILDREN AS A REFERENCE FOR INFERIOR ALVEOLAR NERVE BLOCK USING AN ORTHOPANTAMOGRAPH

Aim and objectives: A crucial component of managing a kid dentistry patient's behavior is pain control. For mandibular teeth, the most used local anesthetic method is inferior alveolar nerve block (IANB). So, an effective IANB anesthetic requires knowledge of the mandibular foramen's location. Using digital panoramic radiography pictures, the mandibular foramen's position in relation to the occlusal plane and the deepest point of the anterior border of the ramus was assessed in a sample of Yemeni children aged 4 to 12. Materials and Methods: This retrospective study consisted of 501 orthodontic charts that were analyzed and divided into three groups: Group 1: 4-6 years, Group 2: 7-9 years and Group 3: 10-12 years. The OPGS were traced directly on radiographic films and measurements were taken from the mandibular foramen to the occlusal level and to the deepest point of the anterior border of the ramus, respectively, on the right and left sides of the mandible. Data were analyzed and the mean and SD were determined and compared for different gender, age groups and side (right/left). Results: Male participants showed slightly higher mean distance values for MF-AB-Right compared to females (16.276±2.03 mm VS 15.952±1.82), but the contrast was not statistically significant. The study found significant differences in the mean MF distances of ABR between the 10-12 year age group and the 4-6 year age group (16.518±1.86 mm VS 15.487±1.95 mm), (p=0.0001). The mean OP-MF distances for the 10-12 year age group were also significant, with significant differences observed in the right side and left side. Conclusion: The results were similar for the total children, regardless of gender. The study suggests that the mandibular foramina position may vary among different age groups. For inferior alveolar nerve block, the needle should be inserted slightly below the OP in 4-6 years old girls and at the same level of OP in 7-9 years old girls, and 4-6 years old boys. Peer Review History: Received 23 March 2024; Revised 6 May 2024; Accepted 29 June; Available online 15 July 2024 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Masoumeh Divar, Shiraz University, Shiraz, Iran, zhaledivar@gmail.com

Superficial skin necrosis as a rare complication of inferior alveolar nerve block in Egyptian child: A case report

AbstractAimThe aim of the presented case report was to report a rare complication of Inferior Alveolar Nerve Block (IANB) in a 5‐year‐and‐4‐month‐old child and to discuss the possible complications.Materials and MethodsFive years and four months old Egyptian male child presented in paediatric dentistry practice complaining of pain in the lower right primary molars that kept him awake all night. Examination revealed decayed lower right primary first and second molars and the treatment plan was designed to include a pulpectomy procedure for tooth 85 and a pulpotomy procedure for tooth 84. Administration of 1 mL of arctician 4% with 1:100,000 epinephrine anaesthetic solution using the inferior alveolar nerve block technique was done uneventfully. Then, the dental procedure was done as usual. The next morning, the child presented to the dental practice with a non‐painful change in colour in the lower part of the child's right cheek, with small scanty blisters.ResultsThe possible causes of such a complication and the proper management are discussed in this article with a confirmation of the superficial skin necrosis as the most possible cause.ConclusionAlthough proper awareness of the anatomical structures of the orofacial region along with meticulous administration technique of local anaesthesia is mandatory for the everyday dental practice, the dentist may face possible, sometimes rare complications of local anaesthesia and he should be able to manage them probably.

A randomized controlled trial to assess parental satisfaction with computerized intraosseous anesthesia versus inferior alveolar nerve block in children

This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P ˂ 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents.

Evaluation of lavender and rose aromatherapies on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized clinical trial

Trial designThis is a prospective, block-randomized, blinded, multiple arm and parallel-group superiority clinical trial. MethodsSeventy-eight patients satisfying the recruitment standards, were randomly allocated into three groups as follows: Group I (n = 26) – Inferior alveolar nerve block (IANB) devoid of aromatherapy (AT); Group II (n = 26) - IANB with lavender AT and Group III - IANB with rose AT (n = 26) with the help of the ultrasonic aroma diffuser (with respective oils)for 20 min/2 h in operatories 1,2 and 3 respectively. For AT, 3–4 drops of lavender and rose-conditioned oils were added from a 100 ml solution containing 100 mg of these medicinal plants. The pre-operative (PRO) and access opening (AO) pain as well as the anxiety of patients were recorded using the Visual Analog Scale (VAS) and Modified Dental Anxiety Scale (MDAS) respectively. Data thus obtained was entered into the Excel sheet and subjected to statistical tests (analysis of variance and paired t-test). The p-value less than 0.05 was considered statistically significant. ResultsGroup I showed non-significant disparity between PRO and AO for both VAS as well as MDAS (p = 0.62, p = 0.71). However, group II (p = 0.04, p = 0.02) and group III (p = 0.03, p = 0.01) revealed significant differences between PO - AO VAS and MDAS. MDAS and VAS intergroup comparison revealed a significant difference among groups I and II (p = 0.03, p = 0.04), and groups I and III (p = 0.02, p = 0.03). However non-significant disparity was observed among groups II and III (p = 0.85, 0.34). Moreover, there was a statistically significant reduction in anxiety levels in females compared to males after rose AT (p = 0.02). Nevertheless, groups I and II did not show any gender predilection for anxiety as well as pain. ConclusionAlleviation of dental anxiety as well as reduction in pain during AO of teeth with SIP can be achieved using Lavender and rose AT. In female patients, rose AT can be preferred over lavender AT.

Do Regional Nerve Blocks During Bimaxillary Surgery Decrease Postoperative Pain and Vomiting Compared With Patient-Controlled Analgesia?

Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting. The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA). This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded. The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA. The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents. The study covariates included demographic, surgical, and anesthesia characteristics. Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher's exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P<.05. 354 participants were included in the study (262 in the nerve block group, mean age 22.5±4.0years; 92 in the PCA group, mean age 22.6±4.4years; P=.81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P=.18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio=0.67, 95% confidence interval: 0.22-2.01, P=.48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio=0.34, 95% confidence interval: 0.18-0.65, P=.001). For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study’s predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18–44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.