Local Anesthesia In Pediatric Patients Research Articles

Evaluating Dentists' Knowledge and Practices in the Use of Local Anesthetics and Unintended Effects in Pediatric Patients

Objective: This cross-sectional study aimed to evaluate a group of Turkish dentists' awareness, preparedness, and competence regarding the unintended effects of LAs in pediatric patients. Methods: In this study, the questionnaire form titled ' Evaluation of the Knowledge Level of Dentists Regarding the Use of Local Anesthesia and its Unintended Effects in Pediatric Patients' prepared in a digital environment was sent to dentists via Google survey application. The study investigated dentists' awareness and knowledge of the maximum dose of local anesthetic (LA) drugs. The most commonly used LA drugs and the most common complications related to these anesthetics were also determined. Results: According to the results obtained, the dentists' most frequently preferred LA substances were Articaine+Adrenaline (A+A) and Lidocaine+Adrenaline (L+A). It was found that 91% of the participants performed aspiration before LA applications. It was found that 74% of the dentists participating in the study did not calculate the maximum dose per kilogram when performing local anesthesia in pediatric patients. The three complications encountered by the participating dentists during local anesthesia were found to be anesthetic failure (73%), facial paralysis (26%), and syncope (19%), respectively. In addition, 90% of the dentists who were asked about the first drug they would prefer in anaphylaxis answered adrenaline. When asked about the route of adrenaline injection, the majority of the dentists (64%) responded intramuscularly. Conclusion: Although the occurrence of anaphylaxis during dental procedures is rare, when it does occur, it can lead to severe complications that may result in death. Dentists should be familiar with the signs of systemic complications that may arise from using LAs. When these findings are encountered after anesthesia, it should be considered that a systemic complication may have occurred, and urgent intervention should be performed. Any delay may cause consequences that may threaten the patient's life. This subject, which is of critical importance in dentistry, should be considered more in undergraduate and postgraduate education, and the level of knowledge should be increased by providing further training courses to update the information.

Enhanced Recovery of Local Anesthesia in Pediatric Patients: The Impact of Photobiomodulation on Reversing Anesthesia Effects.

BACKGROUND The split-mouth study design is used in oral health research and usually consists of 2 treatments randomly assigned to either the right or left side. This split-mouth study aimed to evaluate the efficacy of photobiomodulation on reversal of local anesthesia in 50 children aged 8-10 years. MATERIAL AND METHODS The study was conducted among 50 children: 27 girls and 23 boys, aged 8-10 years (mean age 9.38±1.15 years), who presented 2 carious maxillary permanent molars. One side was randomly assigned to the laser group (50 teeth), and the contralateral side to the control group (50 teeth). At the end of the treatment, photobiomodulation (PBM) was performed in the area of infiltration at 6 points, with 635 nm (25 children) (250 mW, 500 mW/cm², 15J) and 808 nm (25 children) (200 mW, 400 mW/cm², 12J) (SmartM PRO, Lasotronix, Poland). On the contralateral side, the laser's off-mode applicator was used. Anesthetic effect was evaluated by palpation test (soft tissues) and electrical test (dental pulp). RESULTS After 15 minutes, in the laser group the return to normal sensations in the palpation test showed 88% (808 nm) and 68% (635 nm), and only 20% in the control group (P=0.04123). After 45 minutes, all the participants from the PBM group returned to normal sensations (P=0.21458). Dental pulp's excitability threshold was lower for both wavelengths compared to the control group (P=0.000001). CONCLUSIONS The identification of factors accelerating the recovery time to normal function, such as PBM, can be used as important data to eliminate self-injury secondary to local anesthesia (LA) in children.

Comparative evaluation of efficacy of 2% lidocaine and 4% Articaine in paediatric patients during Needle insertion by Conventional and Alternative technique of local Anasthesia

Background: Local anesthesia is an essential part of many dental procedures, particularly in pediatric patients who may be fearful or anxious during treatment. Two of the most commonly used local anesthetics are 2% lidocaine and 4% articaine, but there is ongoing debate about which one is more effective. Additionally, the technique used for administering local anesthesia can also impact pain perception during needle insertion. This topic aims to compare the efficacy of 2% lidocaine and 4% articaine, as well as to evaluate the pain perception of pediatric patients during needle insertion using both conventional and alternative techniques of local anesthesia. Methodology: A total of 180 pediatric patients were included in the study, and they were randomly assigned to receive either 2% lidocaine or 4% articaine using either conventional or alternative techniques. The study included pediatric patients aged 4-12 years, who required dental treatment involving local anesthesia assigned to the following groups. Group 1: 2% lidocaine with conventional technique of local anesthesia; Group 2: 2% lidocaine with alternative technique of local anesthesia; Group 3: 4% articaine with conventional technique of local anesthesia; Group 4: 4% articaine with alternative technique of local anesthesia. Outcome assessed were onset and duration of anesthesia. Results: The results showed that the use of 4% articaine was more effective in increasing the duration of anesthesia and a faster onset than 2% lidocaine, regardless of the technique used. Additionally, the alternative technique was found to be less painful than the conventional technique. Conclusion: This study provides important insights into the use of local anesthesia in pediatric patients and highlights the potential benefits of using 4% articaine and alternative techniques for reducing pain and discomfort during needle insertion.

Assessment of Office-Based Probing with Dacryoendoscopy for Treatment of Congenital Nasolacrimal Duct Obstruction: A Retrospective Study.

We aimed to evaluate the safety and efficacy of office-based probing with dacryoendoscopy under local anesthesia for congenital nasolacrimal duct obstruction (CNLDO). This single-institution study retrospectively reviewed data on 72 eyes of 64 consecutive children (38 boys, 43 eyes; 26 girls, 29 eyes), aged between 6 and 17 (mean age: 10.0 ± 2.7) months with suspected CNLDO, from July 2016 to February 2022. These patients underwent probing with dacryoendoscopy under local anesthesia. CNLDO was diagnosed clinically based on the presence of epiphora and sticky eyes due to mucous discharge commencing within the first 3 months of life, increased tear meniscus height, and fluorescein dye disappearance test results. A total of 63 of the 72 eyes had narrowly defined CNLDO, and 9 eyes had other types of obstructions. The intervention success rate was 100% (63/63 eyes) for patients with typical CNLDO and 97.2% (70/72 eyes) for the entire study cohort. Moreover, CNLDO was classified into five types based on the features of the distal end of the nasolacrimal duct. Probing with dacryoendoscopy is safe and yields a high success rate in pediatric patients with CNLDO. This is the first study to assess the safety and efficacy of probing with dacryoendoscopy under local anesthesia in pediatric patients with CNLDO.

Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6–11 years: A crossover split-mouth study

BackgroundUncooperative behavior of children due to dental anxiety may interfere with the effective delivery of dental care and compromise the quality of treatment provided. Injection of local anesthesia is one of the most anxiety-inducing stimuli in pediatric dentistry. This study aimed to compare the efficacy of a child-friendly device, having a combined effect of vibration and distraction, with the conventional method of injection on pain, anxiety, and behavior of pediatric patients aged 6–11 years.MethodsThis randomized, crossover, split-mouth study included 30 children requiring a bilateral inferior alveolar nerve block. The children were equally divided into two groups: group 1, aged 6–8 and group 2, aged 9–11 years. All children were injected with anesthesia using the conventional and device method in two separate sessions. They were assessed for anxiety by measuring the pulse rate before and during the administration of local anesthesia. Behavior was assessed using Faces, Legs, Activity, Cry, Consolability (FLACC) scale, and the child's experience while receiving anesthesia was assessed using the Wong Bakers Pain Rating Scale.ResultsResults showed that the children who received local anesthesia using the device method had a lower mean pulse rate, FLACC scores, and pain rating scores than those who received local anesthesia using the conventional method.ConclusionThe device method was more effective than the conventional method in managing pain, anxiety, and behavior of patients aged 6–11 years. The device is a cost effective, simple, and child-friendly product for administrating local anesthesia in pediatric patients.

Efficacy of self-designed intraoral appliances in prevention of cheek, lip and tongue bite after local anesthesia administration in pediatric patients.

BackgroundThe occurrence of self-inflicted soft tissue injuries following administration of local anesthesia in pediatric patients who have received dental treatment has been reported. Aim: To evaluate the attitudes and knowledge regarding cheek, lip, and tongue bite post administration of local anesthesia among dental practitioners in Saudi Arabia. Additionally, the efficacies of three types of intraoral appliances on the prevention of self-harm were evaluated in pediatric patients.Material and MethodsA total of 301 practitioners were provided with a questionnaire consisting of 9 items. In addition, three types of intraoral appliances made of polyethylene terephthalate were designed as follows: design 1 (consisted of an anterior extension with numerous perforations); design 2 (had a buccal flap extension); and design 3 (comprised of serrated borders). The appliances were placed in the oral cavities of 45 children (age, 3–15 years) immediately after the completion of the dental procedure. The patient was asked to retain the appliance for 3 h. After 24 h, both parents and children were required to respond to a checklist to evaluate the effectiveness the appliances.ResultsAlmost half of the dental practitioners had never encountered self-inflicted soft tissue injury in children after local anesthesia administration. About 60% of the dentists were of the opinion that provision of adequate instructions after treatment could prevent the occurrence of lip, cheek, and tongue biting. Furthermore, among the three appliances used, design 1 was most well accepted.ConclusionsIntraoral appliances used in this study may be considered for use to prevent self-inflicted soft tissue trauma in children following administration of local anesthesia. Key words:Cheek biting, lip biting, intraoral appliance, local anesthesia.

Budgetary Impact of Medicinal Therapies for Rare Diseases in Bulgaria.

Rare diseases have been continually outlined as one of the causes for the National Health Insurance Fund's (NHIF) deficit spending in Bulgaria. To estimate the budgetary impact of rare disease medicinal therapies from NHIF perspective for 2014 and 2016. Budgetary impact of rare diseases is calculated as a percentage of NHIF total pharmaceutical spending. Total expenditure per ICD-10 code, mean annual number of patients reimbursed and mean annual cost per patient are analysed. Budgetary impact of rare diseases reached a plateau of about 9% of NHIF total pharmaceutical spending for 2014-2016. Mean number of patients reimbursed and mean annual cost per patient increased by median rates of 4.27% and 2.54%, respectively. Glycogen storage disease, neuropathic heredofamilial amyloidosis and C1 esterase inhibitor deficiency stood out, as they had the second, fourth and fifth most expensive medicinal treatment cost. While accounting for only 92 patients in 2016, these three conditions contributed for 22.89% of NHIF total expenditure on rare disease medicinal therapies. For comparison, coagulation defects, with the biggest total cost per indication, had a similar budgetary impact - 24.88%, but for 277 patients reimbursed. Our study does not support the concerns about uncontrolled growth of expenditures for rare disease medicinal therapies. Nevertheless, there is a need for enhanced post-marketing surveillance and performance-based payment of these treatments. Development, collection and analysis of local real-world data have been increasingly applied as a tool to advance these health policy goals.

Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study.

IntroductionUsually discomfort and pain are associated with dental work, especially for young patients. Pain control can be achieved by using anesthesia. Sight of injection can terrify any patient and if the patient is a child it is really difficult to convince them for injections. Alternatives to injections have been explored. Pediatric dentists are using anesthesia in the form of jelly and patch. Recently, the concept of mucosal vibration has been put forward to enhance the effectiveness of local anesthesia.AimThe aim of the present study was to compare and evaluate the effectiveness of lignocaine jelly and mucosal vibration in reducing pain during administration of local anesthesia in pediatric dental patients.Materials and methodsThirty children in the age group 6 to 11 years who required bilateral anesthesia for dental treatment in mandible were selected for this study. Pain was compared using Wilcoxon signed-rank test at the time of injection using Sound, Eye, Motor (SEM) scale as objective criteria and facial pain rating (FPR) scale as subjective criteria after administration of injection by a trained assistant who was blinded to the procedure.ResultsLocal anesthetic injection along with mucosal vibration resulted in significantly less pain (p = 0.001) in comparison with the injections without the use of mucosal vibration.ConclusionThe result shows that mucosal vibration can be used as an effective means to reduce the intensity of pain during local anesthetic injection in dentistry.How to cite this article: Tandon S, Kalia G, Sharma M, Mathur R, Rathore K, Gandhi M. Comparative Evaluation of Mucosal Vibrator with Topical Anesthetic Gel to reduce Pain during Administration of Local Anesthesia in Pediatric Patients: An in vivo Study. Int J Clin Pediatr Dent 2018;11(4):261-265.

PAIN ASSESSMENT DURING THE REMOVAL OF INFECTED CARIOUS DENTIN USING CERAMIC BURS WITHOUT LOCAL ANESTHESIA IN CHILDREN

Negative dental experiences in childhood can lead to dental phobias in adult patients. The dentist’s role is to lessen dental anxiety by providing a pain-free procedure. This could be achieved by using painless procedures in caries removal such as air abrasion, laser, chemo-mechanical, enzymatic techniques, as well as the use of polymer or ceramic burs. Ceramic burs are rotary cutting instruments made of alumina-yttria stabilized zirconia round burs. They work by selective removal of carious infected dentin consequently avoiding pain which could be more appropriate for very young children.The aim of this study was to assess the extent of pain perception using ceramic burs during caries removal without local anesthesia in pediatric patients. This was performed on 51 patients between 4-8 years of age with 2 primary molars showing dentinal caries requiring class I restoration. The first visit (group I) caries was removed by ceramic bur on low speed hand-piece without administration of local anesthesia then the second visit (group II) caries was removed by carbide round bur on low speed hand-piece without administration of local anesthesia. During each procedure, objective assessment for pain was performed using FLACC scale. Upon completion, the pain threshold for caries removal was measured subjectively by Wong Baker faces pain rating scale. The various responses were gathered and subjected to statistical analysis. It was concluded that ceramic burs reduce the pain sensation during removal of infected dentin which ensures excellent patient comfort. There could be some advantages in using the ceramic bur: high acceptance by the patient, reduced pain response and sound pulp protection in deep caries lesions.

Comparative evaluation of the efficacy of 4% articaine and 2% lidocaine in children during the primary maxillary molar extractions

Aims: This study aims to compare and evaluate the efficacy of 4% articaine and 2% lidocaine in children during the primary maxillary molar extractions. Materials and Methods: A total of 102 patients were randomly selected for the study who required maxillary molar extractions and received buccal infiltration either using lidocaine or articaine. Results: Higher mean value for facial pain scale for lidocaine suggesting lesser effectiveness of infiltration was seen in the results. Statistically insignificant changes were seen in heart rate, blood pressure, and difference in Face, Legs, Activity, Cry, and Consolability Scale between articaine and lidocaine. Higher pain scores with lidocaine compared to articaine are shown in the results of the study but are not statistically significant. Conclusions: It can be concluded that articaine is better alternative to lidocaine for local anesthesia in pediatric patients.

Pain Perception: Computerized versus Traditional Local Anesthesia in Pediatric Patients

Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

Systemic toxicity to local anesthesia in an infant undergoing circumcision

A circumcision was planned for a four-month-old infant under local anesthesia. After the application of lidocaine, the infant stopped crying, and then generalized tonic-clonic convulsions and a diffuse erythematous rash developed. The patient was immediately monitored, ventilation was provided, and 1 mg midazolam was given intramuscularly. After insertion of a cannula, sodium thiopental 50 mg was given intravenously, the patient's convulsions were controlled, and endotracheal intubation was performed. The patient was extubated 30 minutes later. However, the patient was re-intubated due to his noisy breathing, and 10 mg prednisolone was given intravenously due to mild edema seen in the larynx during endotracheal intubation. Two hours after the second intubation, the patient started to breath spontaneously and opened his eyes; he was extubated and transferred to the intensive care unit. Two days later the patient was discharged. Systemic toxicity to the local anesthesia was considered in this patient. All precautions need to be considered during the application of local anesthesia in pediatric patients, including proper indication, monitoring of the patient in the preoperative period, establishment of venous access, and readiness to apply cardiopulmonary resuscitation in the event of local anesthetic toxicity. The maximum dose of local anesthesia should be considered and it should be diluted during application.

The Use of Popsicles after Dental Treatment with Local Anesthesia in Pediatric Patients

The purpose of the study was to assess how children felt after dental treatment when receiving apopsicle or a toy Each patient received either a popsicle or a toy after dental treatment on the first visit, and the other on the second visit. A significant difference (p = 0.0235) was found 10 minutes and thereafter 30 minutes after dental treatment. More children reported feeling better when they received a popsicle than when they received a toy.

The Efficacy of Premixed Nitrous Oxide and Oxygen for Fiberoptic Bronchoscopy in Pediatric Patients. A Randomized Double-Blind Controlled Study

Chest. 2004;125:315–21. Fauroux B, Onody P, Gall O, et al Comments: Many bronchoscopists prefer general anesthesia (GA) for performing flexible bronchoscopy in children. Although GA assures patient comfort, and better cough control during bronchoscopy, it is difficult to organize, increases cost of care, and places children at risks associated with anesthesia. Also, dynamic airway abnormalities, an important indication for pediatric bronchoscopy, cannot be evaluated in anesthetized children. As a result of these reasons, some centers prefer to perform bronchoscopy under conscious sedation and local anesthesia in pediatric patients. The aim of this study was to evaluate the efficacy of premixed 50% nitrous oxide and oxygen in improving the quality of sedation and pain control during FB in children. The study included a total of 105 children undergoing diagnostic or therapeutic FB. The patients were randomly assigned to receive either premixed 50% nitrous oxide and oxygen or premixed 50% nitrogen and oxygen. Both the endoscopy team and the patients were blinded to the mixture inhaled. All patients received intrarectal atropine and benzodiazepines. Lidocaine was used for topical anesthesia. The authors used several methods to assess the efficacy of the analgesic agent. The primary outcome measure was the rate of failure of the first inhalation mixture to control pain. The other outcome measures were 1) quality of sedation and pain control assessed using Children's Hospital of East Ontario pain Score (CHEOPS), 2) the patient's self reported assessment, 3) global pain control assessment by the endoscopy team, 4) self-reported pain by children >6 years using a visual analog scale, and 5) assessment of independent blinded observers who reviewed the videotape of the procedure. The failure rate was significantly lower in the nitrogen oxide group compared with the control group (21% vs. 62%, P < 0.05). Other outcome measures also showed a clear advantage of nitrogen oxide and oxygen inhalation during bronchoscopy than the nitrogen and oxygen inhalation. The onset of analgesic effect of inhaled nitrous oxide was rapid and its effect was short-lasting after stopping the treatment. Side effects were minor and were similar in both groups. The adequacy of patient comfort and pain control is an important consideration when bronchoscopy is performed in children. A sizable proportion of adult patient has reported poor pain control during flexible bronchoscopy despite sedation, analgesics, and topical anesthesia (Am J Respir Crit Care Med 2000;162:440–5 ). Similar data are not available in pediatric patients, but there is a general perception that suboptimal pain control during operative procedures is an important problem in pediatric patients. Nitrous oxide therapy has been used for its analgesic properties in various invasive procedures. The therapy has an established safety record in pediatric patients (Lancet 2001;358:1514–5 ), and it is easy to administer. This well-designed study establishes better sedation and pain control with premixed 50% nitrous oxide and oxygen in children undergoing FB. The results will encourage pediatric pulmonologists to incorporate this simple measure to better control pain associated with bronchoscopy in children.

Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients.

Tumescent local anesthesia is a technique for regional anesthesia of the skin and the subcutaneous tissue, using infiltration of large volumes of local anesthetic. The advantages of this technique are (1) simplicity, (2) prolonged postoperative analgesia, (3) low incidence of bleeding, and (4) anesthetization of a large area of the body. There are no reports on the use of tumescent local anesthesia in pediatric patients. In 30 consecutive pediatric burn patients with American Society of Anesthesiologists physical status class I or II who were 1-120 months old (34 +/- 31.6 months), after induction of anesthesia with nitrous oxide-oxygen-sevoflurane, infiltration with 0.05% (14 ml/kg) or 0.1% (7 ml/kg) lidocaine solution was performed. Anesthesia was maintained with patients spontaneously breathing with 1.5% sevoflurane in nitrous oxide-oxygen (50%). The maximum dose of lidocaine used was 7 mg/kg. Postoperative pain was assessed by using the Children's Hospital of Eastern Ontario Pain Scale (for patients aged up to 5 yr) and by using a visual analog scale (for patients older than 5 yr). A comparison with a historic control group not treated with the tumescent local anesthesia technique was performed. No patients were excluded from the study, and no significant variations in the monitored intraoperative parameters were observed. Five patients had an increase in heart rate and respiratory rate at the beginning of surgery, and of these, two needed a temporary increase in sevoflurane concentration. After the initial incision, no response to painful stimulus was observed. No complications occurred. Six patients required postoperative acetaminophen administration, and 24 patients did not require analgesic treatment. Tumescent local anesthesia with maximum dose of 7 mg/kg lidocaine seems to be safe and the sole possible effective locoregional anesthesia technique for the surgical treatment of noncontiguous pediatric burns.

Preventing Local Anesthesia Toxicity

In “Preventing Local Anesthesia Toxicity: A Case Report,” Dr. Paul A. Moore provides guidelines for using local anesthesia in pediatric patients. A pediatric patient’s rare reaction to amide local anesthesia calls for a review of the prevention and treatment of toxic reactions.

Local anesthesia in pediatric patients: Topical TAC versus lidocaine

Lacerations requiring sutures are a common surgical emergency in children. Traditional anesthesia prior to suturing has been intradermal lidocaine. TAC (0.5% tetracaine, 1:2,000 adrenalin, 11.8% cocaine) is a topically applied anesthetic. A randomized, placebo-controlled, double-blind clinical study was conducted to test the hypothesis that topical TAC and intradermal lidocaine are equally efficacious with respect to patient compliance with the suturing process, ie, anesthetic application and placement of sutures, and development of wound complications. Patients less than 18 years old, with lacerations 5 cm or less in length, located in well vascularized, nonmucous membrane areas were included. Patients were entered into the intradermal or topical groups; the intradermal group received lidocaine and the topical group was randomized to receive either TAC or placebo. One hundred fifty-one patients were enrolled in the study. There was no significant difference in the rates of successful initial anesthesia with TAC (89%) and lidocaine (79%). TAC was significantly better (P less than .002) with regard to patient compliance with the suturing process than lidocaine or placebo. Seventeen percent of patients who received placebo had initial anesthesia. These results suggest that TAC, when applied correctly, may be the preferred anesthetic for laceration repair in children.