Buffered Lidocaine for Incision and Drainage: A Prospective,Randomized Double-blind Study

IntroductionBuffered local anesthetics have not been studied for incision and drainage procedures in dentistry. The purpose of this prospective, randomized, double-blind study was to compare the pain of infiltration and pain of an incision and drainage procedure by using a buffered versus a nonbuffered 2% lidocaine with 1:100,000 epinephrine solution in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.MethodsEighty-one adult patients were randomly divided into 2 treatment groups who received 2 infiltrations (mesial and distal to the swelling of the same formulation) by using either 2% lidocaine with 1:100,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:100,000 epinephrine. Patients rated pain of needle insertion, placement, and solution deposition for each infiltration on a 170-mm visual analog scale. An incision and drainage procedure was performed, and the pain of incision, drainage, and dissection was recorded.ResultsNo significant differences were found between the 2 anesthetic formulations for pain of solution deposition for either the mesial or distal site infiltrations. Moderate-to-severe pain was experienced in the majority of patients with the incision and drainage procedure. No significant differences were found between the 2 formulations.ConclusionsThe addition of a sodium bicarbonate buffer to 2% lidocaine with 1:100,000 epinephrine did not result in significantly decreased pain of infiltrations or significantly decreased pain of the incision and drainage procedure when compared with 2% lidocaine with 1:100,000 epinephrine in symptomatic patients with a diagnosis of pulpal necrosis and associated acute swelling.     

Comparison of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine when used as a supplemental anesthetic

A randomized, double-blind trial was conducted to compare the efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine when used as a supplemental anesthetic. Forty-eight patients with irreversible pulpitis requiring supplemental buccal infiltration for endodontic therapy were given either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine in a double-blind manner. A standard VAS pain scale was used to evaluate the patient's response to pain after a supplemental injection. The mean VAS score after supplemental anesthesia was 15.28 for 4% articaine with 1:100,000 epinephrine and 19.70 for 2% lidocaine with 1:00,000 epinephrine. The mean percentage change in VAS score was 70.5 and 62.2% for articaine and lidocaine, respectively. There was no statistically significant difference in the VAS pain score between 4% articaine with 1:00,000 epinephrine and 2% lidocaine with 1:00,000 epinephrine as a supplemental anesthetic.     

Injection pain and postinjection pain of the palatal-anterior superior alveolar injection, administered with the Wand Plus system, comparing 2% lidocaine with 1:100,000 epinephrine to 3% mepivacaine

PURPOSE: The purpose of this prospective, randomized, double-blind study was to compare injection pain and postinjection pain of 2% lidocaine with 1:100,000 epinephrine and 3% mepivacaine using the computer-assisted Wand Plus injection system to administer the palatal-anterior superior alveolar (P-ASA) injection. Additionally study was done to determine if the use of topical anesthetic decreased the pain of needle insertion with the P-ASA injection. STUDY DESIGN: Using a crossover design, 40 subjects randomly received, in a double-blind manner, P-ASA injections of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine and 1.4 mL of 3% mepivacaine, at 2 separate appointments. The P-ASA injection was administered, utilizing the Wand Plus system, 6 to 10 mm into the incisive canal located lingual to the central incisors. The pain of needle insertion, needle placement, solution deposition and postinjection pain were recorded on a Heft-Parker visual analog scale for the 2 P-ASA injections. Eighty injections were randomly administered in the study, 40 using topical anesthetic gel and 40 using a placebo gel. RESULTS: For needle insertion, 30% of the subjects reported moderate/severe pain with the lidocaine solution and 43% reported moderate/severe pain with the mepivacaine solution. There was no significant difference (P > .05) between the topical and placebo groups. For needle placement into the incisive canal, 54% of the subjects reported moderate/severe pain with the lidocaine solution and 58% reported moderate/severe pain with the mepivacaine solution. For anesthetic solution deposition, 8% of the subjects reported moderate pain with the lidocaine solution and 12% reported moderate pain with the mepivacaine solution. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Regarding postinjection pain, when anesthesia wore off on the day of the injection, 20% of the subjects reported moderate/severe pain with the lidocaine solution and 14% reported moderate/severe pain with the mepivacaine solution. Pain ratings decreased over the next 3 days. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. Postinjection, 12% and 18% of the subjects experienced temporary numbness/paresthesia of the incisive papilla with the lidocaine and mepivacaine solutions, respectively. Twenty percent and 28% of the subjects had incisive papilla swelling or soreness with the lidocaine and mepivacaine solutions, respectively. There were no significant differences (P > .05) between the lidocaine and mepivacaine solutions. CONCLUSIONS: The P-ASA injection of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine, administered with the Wand Plus, has the potential to be a painful injection. The use of topical anesthetic did not significantly reduce pain of needle insertion when compared to a placebo. The incidence of postinjection pain, temporary numbness/paresthesia, and incisive papilla swelling or soreness would indicate that some pain and problems occur with the P-ASA technique, regardless of whether 2% lidocaine with 1:100,000 epinephrine or 3% mepivacaine is used.     

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??Objective    To compare the different effect of lidocaine on reducing the postoperative pain as inferior alveolar nerve block anesthesia solution between Han and Uygur patients in first or second mandibular molar with irreversible pulpitis after single-visit root canal treatment??in order to provide a better basis for personalized clinical administration.Methods    In this clinical controlled experiments??30 Han and 30 Uygur patients were selected??whose first or second mandibular molar was diagnosed with irreversible pulpitis??and received 2% lidocaine with 1??80 000 epinephrine as the anesthetic solutions for inferior alveolar nerve blocks before single-visit root canal treatment. Each patient was asked to record their pain score on a visual analogue scale??VAS??at 6??12??24 and 48 hours after treatment. Patients were instructed that they could use analgesics??ibuprofen 300mg??Xiehe Pharmaceutical Co. Ltd.??every 6 hours??if they felt intolerable pain. Data were analyzed by Mann-Whitney test??χ2 test??Cochrane Q and T tests as well as Pearson correlation analysis. Results    The experimental data showed that postoperative pain scores of the Han patients were significantly lower than Uygur patients′scores??P??0.05??at 6 ~12 h after single-visit root canal treatment. The use of analgesia drug in Han patients was also less than Uygur patients??P??0.05??. Conclusion    Han patients who receive lidocaine as anesthetic solution before single-visit root canal treatment for irreversible pulpitis in first or second mandibular molars have significantly less postoperative pain and use fewer analgesics than Uygur patients.     

汉族与维吾尔族不可复性牙髓炎一次性根管充填治疗后利多卡因镇痛效果对比研究

目的    通过临床对照试验,比较汉族与维吾尔族下颌第一或第二磨牙不可复性牙髓炎患者一次性根管充填治疗术后,应用利多卡因行下牙槽神经阻滞麻醉疼痛缓解的差异,为临床针对不同患者采取个性化治疗提供依据。方法    选取汉族与维吾尔族下颌第一或第二磨牙不可复性牙髓炎患者各30例,均为新疆医科大学第二附属医院口腔科2016年1—6月9：00-13：00就诊的门诊患者。在根管治疗前应用含有1∶80 000肾上腺素的利多卡因注射液5 mL,实施患侧的下牙槽神经阻滞麻醉术,之后一次性完成根管预备和根管充填。治疗结束后,嘱患者若术后感觉疼痛无法承受,遵说明书服用布洛芬缓释胶囊并记录服药剂量与时间。患者需在术后6、12、24、36、48 h利用可视化痛觉量表（VAS）记录疼痛强度,在第5天复诊时交回问卷。所得数据分别利用Mann-Whitney秩和检验、卡方检验、Cochrane Q和t检验以及Pearson correlation进行统计学分析。结果    根管治疗后6、12 h,汉族患者疼痛分值明显小于维吾尔族患者（P＜0.05）。维吾尔族患者术后镇痛药物的服用量也多于汉族患者（P＜0.05）。结论    使用利多卡因进行下牙槽神经阻滞麻醉术的下颌磨牙不可复性牙髓炎患者中,维吾尔族患者较汉族患者更容易出现术后疼痛,疼痛程度也更为剧烈,维吾尔族患者会在一次性根充治疗后,倾向于服用更大剂量的镇痛药物。     

A Comparison of the Anesthetic Efficacy of Articaine and Lidocaine in Patients with Irreversible Pulpitis

The purpose of the present study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in mandibular posterior teeth. Forty volunteers, patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo, randomly received a conventional inferior alveolar nerve block containing 3.6 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. During the subsequent pulpectomy, we recorded the patients' subjective assessments of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation, and the absence/presence of pain through a verbal analogue scale. All tested patients reported lip anesthesia after the application of either inferior alveolar nerve block. Regarding pulpal anesthesia success as measured with the pulp tester, the lidocaine solution had a higher success rate (70%) than the articaine solution (65%). For patients reporting none or mild pain during pulpectomy, the success rate of the articaine solution (65%) was higher than that of the lidocaine solution (45%). Yet, none of the observed differences between articaine and lidocaine were statistically significant. Apparently, therefore, both local anesthetic solutions had similar effects on the patients with irreversible pulpitis in mandibular posterior teeth. Neither of the solutions, however, resulted in an effective pain control during irreversible pulpitis treatments.     

Use of Pre-Injection Diffusion of Local Anaesthetic as a Means of Reducing Needle Penetration Discomfort

Aim

To determine if pre-injection diffusion of local anaesthetic solution influences the discomfort of needle penetration in the palate.

Methods

A placebo-controlled, randomised, double-blind split-mouth investigation was conducted. 25 healthy adult volunteers were recruited and each received two needle penetrations in a random order during one visit. The penetration sites were 1 cm from the gingival margin of the first maxillary premolars on each side of the mouth. 30 gauge-13 mm needles which were attached to syringes that contained either 2% lidocaine with 0.125mg/ml epinephrine or physiological saline were used. For each penetration an operator encouraged a drop of solution to appear at the end of the needle and placed this drop with the bevel of the needle flat on the palate for 20 seconds. The discomfort was noted on a 100 mm visual analogue scale with end points marked “No pain” and “Unbearable pain”.

Results

There was no significant difference in penetration discomfort between solutions, (mean VAS = 26.80±19.36mm for lidocaine and 26.20±18.39mm for saline) however the 2nd penetration was significantly more uncomfortable than the first (mean VAS = 31.00±19.84 mm and 22.00±16.65 mm respectively).

Conclusion

Pre-injection diffusion of local anaesthetic solution did not influence the discomfort of needle penetration in the palate.Key words: diffusion, pre-injection, local anaesthesia, pain     

Anesthetic Efficacy of Supplemental Buccal and Lingual Infiltrations of Articaine and Lidocaine after an Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

IntroductionThe success rate of inferior alveolar nerve block (IANB) decreases in patients with irreversible pulpitis. It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates.MethodsEighty-four adult volunteers, actively experiencing pain, participated in this prospective, randomized, double-blinded study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive supplemental infiltrations (control). Thirty patients received supplemental buccal and lingual infiltrations of 2% articaine with 1:200,000 epinephrine, and 30 patients received buccal and lingual infiltrations of 2% lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as “none” or “mild” pain.ResultsStatistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2% lidocaine with 1:200,000 epinephrine or 4% articaine with 1:200,000 epinephrine improved the success rate from 33% to 47% and 67%, respectively. Also the success rate with 4% articaine with 1:200,000 epinephrine was significantly more than 2% lidocaine with 1:200,000 epinephrine (p < 0.05).ConclusionsAlthough supplemental buccal and lingual infiltrations of 4% articaine or 2% lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis, none of the techniques provided acceptable success rates.     

比较曲马多与小剂量氯胺酮对瑞芬太尼麻醉术后的镇痛作用

目的　比较曲马多和小剂量氯胺酮对瑞芬太尼麻醉术后的镇痛作用,为临床合理应用瑞芬太尼提供依据。方法　选择美国麻醉医师协会分级为Ⅰ~Ⅱ级的口腔颌面外科手术患者60例,随机分为对照组(C组)、曲马多组(T组)和小剂量氯胺酮组(K组),每组20例。3组均采用静吸复合麻醉,术毕T组给予曲马多0·3 mg/kg、K组给予氯胺酮0·5 mg/kg镇痛,C组暂不给药,当患者出现中等程度疼痛时给予曲马多0·3 mg/kg。记录3组患者拔除气管导管后的口述疼痛评分,拔管后1、2、3、4、12、24 h的视觉疼痛模拟评分(VAS),再次要求镇痛的时间和拔管后 24 h内的不良反应。结果　3组间拔管后的口述疼痛评分无统计学差异,术后1、2、3、4 h的VAS则有统计学差异, K组在4个时间点均低于C组,2、3、4 h时低于T组(P<0·05),而3、4 h时T组与C组间无统计学差异。C、T组患者再次要求镇痛时间均较K组提前;3组间麻醉后不良反应无统计学差异(P>0·05)。结论　小剂量氯胺酮对采用瑞芬太尼麻醉手术的术后疼痛有明显的抑制作用。     

Lidocaine 20% patch vs lidocaine 5% gel for topical anaesthesia of oral mucosa

Background. Topical anaesthetics are important to provide pain control at dental injection. Aim. The aim was to evaluate the effectiveness of the intraoral topical anaesthetics lidocaine 20% patch (DentiPatch™) and lidocaine 5% gel. Design. The randomized unblinded cross-over study included 31 patients (ten boys, 21 girls) aged 13.5 ± 2.5 years. Application of lidocaine patch or gel was randomly used at first and second visit in the upper premolar region. Heart rate was measured before and at each needle insertion after 2.5, 5, and 15 min and at injection after 15 min. Discomfort and pain were expressed in visual analogue scales (VAS). Paired t-test and Mann–Whitney U-test were used for statistic analyses. Results. Heart rate at buccal injection decreased more when the patch was used (P = 0.0149). Heart rate was lower at the second visit (P = 0.0287). Patients expressed less discomfort when the patch was used on both buccal (P = 0.0150) and palatal (P = 0.0391) site. Boys had lower heart rate and VAS pain scale ratings than girls. Conclusions. Good pain control can reduce the patients’ anxiety level – expressed in heart rate – at the second appointment. The patch and gel seem to provide similar pain reduction at needle stick and injection of local anaesthetics.     

Efficacy of anterior and middle superior alveolar (AMSA) anesthesia using a new injection system: the Wand.

OBJECTIVE: This study examined the effect of anterior and middle superior alveolar (AMSA) field block of maxillary nerves using a new local anesthetic system--the Wand. METHOD AND MATERIALS: Twenty healthy volunteers aged 23 to 44 years were used in the study. Either side of the maxillary teeth was randomly selected for AMSA injection; the other side was left as a control. For each side, 1.8 mL of 2% lidocaine solution with 1/80,000 epinephrine was injected by the Wand on a point that bisects the maxillary first and second premolars and is midway between the crest of the free gingival margin and the midpalatine suture. Pain rating score (PRS) and visual analogue scale (VAS) were applied for measurement of puncture, insertion, and injection pain. Electric pulp stimulation was given to each maxillary tooth every 10 minutes for 1 hour after the injection in order to find out the specific tooth on which AMSA injection was effective. RESULTS: During needle insertion, 14 out of 20 subjects answered moderate pain and VAS showed 27.3 mm (mean). During injection, 11 of 20 revealed no pain and the mean of VAS was 14.5 mm. No one claimed severe pain by PRS. Electric pulp stimulation indicated that lateral incisors, canines, and first and second premolars were more anesthetized than central incisors and first molars. CONCLUSION: AMSA injection using the Wand method seems to avoid severe injection pain and seems to be very effective for pulpal anesthesia at lateral incisors, canines, and premolars.     

A randomised, double-blind, placebo-controlled, comparative study of topical skin analgesics and the anxiety and discomfort associated with venous cannulation

OBJECTIVES: To compare the effect of topical skin anaesthetic agents on the discomfort and anxiety associated with venous cannulation. DESIGN: Randomised, double-blind, placebo-controlled, within subject, volunteer trial. METHODS: 20 healthy volunteers underwent venous cannulation on three separate occasions having received topical skin application of either 4% amethocaine gel (Ametop), 5% eutectic mixture of lidocaine and prilocaine (EMLA) or E45 cream (placebo). Visual analogue and verbal rating scales were used to assess pain and anxiety associated with the venous cannulation, and anticipated anxiety for future cannulation, under each drug condition. RESULTS: Subjects were aged 22-53 years (mean 32.8 years). The mean visual analogue scores (VAS) for discomfort were found to be significantly lower (p< 0.001) with Ametop (VAS = 18mm) and EMLA (VAS = 29mm) compared with the control (VAS = 38mm). There was a positive correlation (R2 = 72%, p<0.001) between discomfort and the predicted anxiety if cannulation was to be repeated with the same cream. With the placebo a positive correlation (R2 = 19.8%, p = 0.05) was found between the level of anxiety before cannulation and the level of discomfort recorded. CONCLUSIONS: Ametop and EMLA topical anaesthetic agents produce effective skin analgesia for venous cannulation. The use of topical analgesia can reduce perceived anxiety about future cannulation procedures. This has application in the management of anxious patients undergoing intravenous sedation, suggesting that topical analgesia prior to venous cannulation may significantly aid anxiolysis.     

Anesthetic Efficacy of a Combination of 4% Prilocaine/2% Lidocaine with Epinephrine for the Inferior Alveolar Nerve Block: A Prospective,Randomized, Double-blind Study

Introduction

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs).

Reduction of pain from needle stick in the oral mucosa by topical anesthetics: a comparative study between lidocaine/prilocaine and benzocaine

OBJECTIVE: The aim of the study was to compare the analgesic effect of a topical benzocaine gel with that of a topical gel mixture of lidocaine/prilocaine (L/P). METHODOLOGY: Forty individuals took part in the study. Topical anesthetics were applied bilaterally in the maxillary vestibule lateral to the canine. On one side, a mixture of 2.5% lidocaine/2.5% prilocaine (EMLA) was applied. On the opposite side, 20% benzocaine (Topex) was applied as control. The patients had no knowledge as to which side each gel was applied. A 27-gauge needle was inserted through the mucosa to bone contact every minute during a seven-minute period in each area of application. The subjects recorded which side was the least painful, and also registered the grade of pain on a 100 mm VAS scale. Comparisons were made estimating the group difference using the Wilcoxon rank sum test. RESULTS: After one minute, 87.5% of the subjects reported the L/P side being the least painful. After two to four minutes, 97.5-100% reported the L/P side least painful. After five to seven minutes, 90-95% reported the L/P side least painful. The VAS grading of the pain showed that L/P was significantly (p < 0.05) better in eliminating or reducing the pain. CONCLUSION: Topical anesthetics based on a combination of lidocaine 2.5% + prilocaine 2.5% are significantly more effective than 20% benzocaine in reducing pain from needle stick in the maxillary vestibular mucosa.     

ANALGESIC EFFICACY OF TRAMADOL/DEXKETOPROFEN VS IBUPROFEN AFTER IMPACTED LOWER THIRD MOLAR EXTRACTION: A RANDOMIZED CONTROLLED CLINICAL TRIAL

ObjectiveImpacted third molar extraction is associated with acute moderate-to-severe pain for up to 48 hours post-surgery. This trial was designed to compare the analgesic effectiveness, swelling, and adverse events after impacted third molar surgery following multimodal therapy with 75 mg tramadol hydrochloride plus 25 mg dexketoprofen or monotherapy with 400 mg ibuprofen.MethodsSeventy-two patients were randomly assigned to receiving ibuprofen (n = 36) or tramadol-dexketoprofen (n = 36). Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a 4-point verbal rating scale; the rescue medication requirement, adverse effects, and global impression of the medication were recorded.ResultsNo statistically significant between-group difference in pain intensity was observed at any time point; however, pain relief was significantly higher in the tramadol-dexketoprofen treated-group at 6 and 36 hours. Self-reported verbal rating scale assessments showed significantly lower swelling in the tramadol-dexketoprofen group at 24 hours post-surgery but not at 48 or 72 hours, and VAS-swelling scores showed no significant between-group difference. The frequency of postoperative nausea and dizziness was significantly higher in the tramadol-dexketoprofen group.ConclusionsMultimodal therapy proved more effective to manage moderate-severe pain after impacted third molar surgery in comparison to monotherapy. However, the improvement in relief must be balanced against the increased risk of adverse effects when considering this multimodal approach.     

Reducing pain from palatal needle stick by topical anesthetics: a comparative study between two lidocaine/prilocaine substances

OBJECTIVE: The aims of this study were to compare the topical anesthetic effect of two different preparations of lidocaine/prilocaine, cream versus thermosetting gel, on the reduction of pain from needle stick in the palate. The study also compared the subjects' preferences with regard to the substances. METHODS: Two preparations of 2.5% lidocaine/2.5% prilocaine topical anesthetic agents were applied on the palatal mucosa in the canine region bilaterally and blindly to forty subjects. In the same visit, the cream (EMLA) was applied on one side and the thermosetting gel (Oraqix) on the other side, simultaneously. After that, a needle stick was given on each side using a 27-gauge needle inserted to bone contact through the palatal mucosa every second minute during a ten-minute period. Immediately after the needle stick, the subjects started recording their findings using a verbal scale, a visual analogue scale, and a questionnaire form. Significant differences were set at p < 0.05. RESULTS: Both substances reduced or eliminated pain from needle stick in the palate. Significant differences in pain reduction were observed between the two substances. EMLA reduced pain significantly better than Oraqix. With regard to comfort, taste, anesthetic effect, personal preference, and recommendation, the majority of the subjects favored the EMLA cream to the thermosetting gel. No adverse effects were reported by the subjects. CONCLUSION: Although both topical anesthetic agents are similar in content, the cream seemed to be preferred by the patients and reduced pain from needle stick in the palate significantly better than the thermosetting gel.     

Evaluation of etidocaine hydrochloride for local anesthesia and postoperative pain control in oral surgery

Etidocaine hydrochloride, an amide-type local anesthetic with prolonged duration of action, was evaluated and compared with a standard local anesthetic, lidocaine, to determine its efficacy as a local anesthetic and its effect on postoperative pain following removal of impacted third molars. The findings indicate that 1.5% etidocaine hydrochloride with 1:200,000 epinephrine, in comparison with 2% lidocaine hydrochloride with 1:100,000 epinephrine, suppresses the magnitude of postoperative pain, and results in anesthesia comparable with that obtained by lidocaine, but results in greater blood loss during surgery.     

A Prospective,Randomized, Double-blind Comparison of 2% Lidocaine With 1:100,000 and 1:50,000 Epinephrine and 3% Mepivacaine for Maxillary Infiltrations

IntroductionThe purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine in maxillary lateral incisors and first molars.MethodsSixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine at three separate appointments spaced at least 1 week apart. The teeth were pulp tested in 3-minute cycles for a total of 60 minutes.Results and ConclusionsAnesthetic success and the onset of pulpal anesthesia were not significantly different between 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine and 3% mepivacaine for the lateral incisor and first molar. Increasing the epinephrine concentration from 1:100,000 to 1:50,000 in a 2% lidocaine formulation significantly decreased pulpal anesthesia of short duration for the lateral incisor but not the first molar. For both the lateral incisor and first molar, 3% mepivacaine significantly increased pulpal anesthesia of short duration compared with 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine.     

Comparison of etidocaine and lidocaine for control of intra- and post-operative bleeding and pain

Etidocaine hydrochloride, an amide-type of local anesthetic with prolonged duration of action, was evaluated and compared with the standard local anesthetic lidocaine to determine its efficacy of action and its effect on bleeding during and following the removal of impacted mandibular third molar teeth. The findings indicate that 1.5% etidocaine hydrochloride with 1:200,000 epinephrine, in comparison with 2% lidocaine with 1:100,000 epinephrine, produces anesthesia comparable to that obtained with lidocaine but results in greater measured intraoperative blood loss.     

Does the Combination of 3% Mepivacaine Plain Plus 2% Lidocaine with Epinephrine Improve Anesthesia and Reduce the Pain of Anesthetic Injection for the Inferior Alveolar Nerve Block? A Prospective,Randomized, Double-blind Study

Introduction

In theory, using 3% mepivacaine initially for an inferior alveolar nerve (IAN) block would decrease the pain of injection, provide faster onset, and increase anesthetic success. The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with a combination of 3% mepivacaine/2% lidocaine (1:100,000 epinephrine) versus a combination of 2% lidocaine (1:100,000 epinephrine)/2% lidocaine (1:100,000 epinephrine) in IAN blocks. Injection pain was also studied.

Methods

One hundred asymptomatic subjects were randomly given a combination of a 1-cartridge volume of 3% mepivacaine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine and a combination of a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine plus a 1-cartridge volume of 2% lidocaine with 1:100,000 epinephrine for the IAN block at 2 separate appointments. Subjects rated the pain of injection. The molars, premolars, and incisors were tested with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes after completion of the IAN blocks and sustaining the 80 reading for 60 minutes.

Results

Success was not significantly different (P > .05) between the 2 combinations. No statistical differences in injection pain or onset times were found.

Conclusions

The combination of 3% mepivacaine plus 2% lidocaine with 1:100,000 epinephrine was equivalent to the combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine in terms of injection pain, onset time, and pulpal anesthetic success for the IAN block.