甲哌卡因在牙体牙髓病治疗中的应用

目的评价2%甲呱卡因在口腔临床局部麻醉应用中的有效性及安全性。方法将注射用2%甲呱卡因用于II例患者的深龋备洞或开髓治疗的局部浸润麻醉,观察麻醉时间、麻醉效果、对心血管的影响及其他不良反应,并与7例采用2%利多卡因麻醉作对照。结果试验组的麻醉起效时间短于对照组,而麻醉持续时间长于对照组,医生评价良好率达到90.91%。两组药物均不引起血压、心率的明显变化。结论2%甲呱卡因是一种安全可靠、麻效较好的口腔用局部麻醉剂。     

牙科治疗用阿替卡因或甲哌卡因局麻的效果

目的：比较阿替卡因和甲哌卡因在牙科治疗中的局麻效果及安全性。方法：将需要在牙体、牙周、修复和外科拔牙治疗中采用局部麻醉的病人各60例随机分成甲、乙两组，分别采用阿替卡因、甲哌卡因进行局部麻醉，监测麻醉前后病人的血压和心率，用疼痛行为法和视觉模拟疼痛法（VAS评分法）进行疼痛评分并记录局麻副作用。结果：两种麻药安全性好，在不同牙科治疗时阿替卡因的平均评分值低于甲哌卡因，但尚无明显统计学差异。结论：采用阿替卡因、甲哌卡因局麻下进行牙科治疗，效果相近，安全可靠，建议推广使用。     

阿替卡因与甲哌卡因在老年人磨牙牙髓治疗中的临床效果比较

目的：比较阿替卡因和甲哌卡因在老年人口腔局部麻醉的临床效果。方法：将346例急慢性牙髓炎老年患者随机分成2组进行局部浸润麻醉,对其注射时疼痛、牙髓治疗时麻醉效果、上下颌的麻醉差异进行观察分析。结果：甲哌卡因和阿替卡因在注射时的疼痛程度无显著性差异。相同颌位时,甲哌卡因和阿替卡因的局部浸润麻醉效果无显著性差异;而在不同颌位时,甲哌卡因和阿替卡因对上颌磨牙的麻醉效果均优于下颌磨牙。结论：阿替卡因和甲哌卡因注射疼痛小,麻醉效果相似。     

罗哌卡因应用于高血压患者上颌磨牙拔除的效果观察

目的 观察罗哌卡因应用于轻中度原发型高血压患者上颌磨牙拔除的麻醉效果.方法 将90例需要拔除上颌磨牙的轻中度原发型高血压患者随机分成两组,实验组采用罗哌卡因进行局部麻醉,对照组采用利多卡因.分别记录并比较两组麻醉起效时间、麻醉持续时间、拔牙术后不同时间点的疼痛程度(VAS分级).实验组麻醉前后患者不同时间点的血压及心率;并对麻醉并发症进行监测记录.结果 实验组的麻醉起效时间明显短于对照组(P<0.05),而麻醉持续时间明显长于对照组(P<0.05).实验组患者术后30min VAS分级较对照组无明显区别(P=0.05),而术后4h VAS分级明显低于对照组(P<0.05),患者术后主动要求服用止痛药的比例明显低于对照组(P<0.05).实验组高压和低压在麻药注射后各个时间点较注射前均无明显变化(P>0.05).心率在麻药注射结束当时、注射后10min、30min、60min均有有小幅度降低(P<0.05).两组在注射麻药后均未产生明显的麻醉并发症.结论 罗哌卡因较利多卡因麻醉起效时间短、麻醉持续时间长,术后疼痛程度低,可广泛应用于轻中度原发型高血压患者的口腔麻醉.     

盐酸甲哌卡因制剂应用于临床拔牙术的综合效能评价

甲哌卡因(mepivacaine)又名卡波卡因(carboeaine)，和阿替卡因(articaine)同属酰胺类局部麻醉剂。近年来，盐酸阿替卡因制剂(碧兰麻)因其可靠的麻醉效果和良好的安全性能，在口腔临床治疗中得到了广泛的认可和应用。而同类麻醉剂中，盐酸甲哌卡因制剂(斯康杜尼)虽然在国外应用多年，但国内却少有报道。本文以碧兰麻为参照标准，对甲哌卡因制剂斯康杜尼的临床效能进行综合评价。     

盐酸甲哌卡因/肾上腺素注射液麻醉根髓疗效观察

目的 了解盐酸甲哌卡因/肾上腺素注射液对牙髓的麻醉效果。方法 选择根管预备时探查疼痛不能拔髓的患者120例共120颗牙,随机分为盐酸甲哌卡因/肾上腺素注射液组和复方盐酸阿替卡因注射液组,两组均直接将麻醉药加压注射入牙髓腔中,用量0.2～0.3ml,30s后即进行治疗,并观察疗效。结果 两组麻醉效果无明显差异。结论 盐酸甲哌卡因/肾上腺素注射液能快速有效麻醉根髓完成拔髓。     

斯康杜尼在下颌传导麻醉中的初步应用

斯康杜尼(septanest)是由法国口腔材料生产公司SEPTODONT生产的一种口腔专用麻醉剂,成分为盐酸甲哌卡因,应用初期因未配备较长针头,无法进行下颌传导麻醉。过去文献中多以上颌局部浸润麻醉疗效报道为主,但文章同时指出局部浸润麻醉方法在下颌尤其是下颌后牙中的疗效却不尽如人意     

罗哌卡因用于下颌阻生智齿拔除麻醉效果观察

目的    观察评价罗哌卡因应用于下颌阻生智齿拔除的麻醉效果。方法    将2016年1—6月首都医科大学附属北京友谊医院口腔科就诊的150例需要拔除下颌阻生智齿且无其他系统疾病的患者随机分成2组：试验组（71例）采用0.75%罗哌卡因进行局部麻醉,对照组（79例）则采用2%利多卡因进行局部麻醉。记录麻醉起效时间、麻醉持续时间、拔牙术后不同时间点的疼痛程度（VAS分级）、术后患者是否主动要求服用止痛药、麻醉前后不同时间点患者血压及脉搏,并对麻醉并发症进行监测记录,从而比较两种药物的麻醉效果。结果    试验组麻醉起效时间明显短于对照组（P＜0.05）,而麻醉持续时间明显长于对照组（P＜0.05）;试验组患者术后不同时间点VAS分级均明显低于对照组（P＜0.05）,且患者术后主动要求服用止痛药的比率明显低于对照组（P＜0.05）;对照组患者血压及脉搏在麻药注射结束后各个时间点较注射前均无明显变化（P＞0.05）;试验组血压在麻药注射后各个时间点较注射前无明显变化（P＞0.05）,脉搏在注射后30 min有小幅度下降（P＜0.05）;两组患者注射麻药后均未产生麻醉并发症。结论    罗哌卡因因其麻醉起效时间短,麻醉持续时间长,术后阵痛效果好,心血管系统风险小等优点可广泛应用于时间较长的复杂口腔专业操作。     

斯康杜尼对上颌磨牙牙髓的麻醉效果观察

目的:探讨斯康杜尼对上颌磨牙牙髓的麻醉效果及不良反应.方法:选择207 例243 颗上颌磨牙牙髓炎的患者,随机分为A、B、C 3 组,每组各69 例.A组、B组均采用盐酸甲哌卡因/肾上腺素注射液(斯康杜尼)颊侧黏膜下浸润麻醉,A组剂量1.8 ml;B组剂量0.9 ml;C组采用2%的盐酸利多卡因传统阻滞麻醉,剂量5 ml.通过0～10数字疼痛强度量表(numerical rating scale,NRS)对注射和操作开髓、拔髓的疼痛程度进行评分,对比其麻醉效果及不良反应.结果:用q检验(Student-Newman-Keuls,SNK)法和q′检验 (Duncan)法检验A、B、C 组注射疼痛评分分别为2.10±2.24、1.93±2.07、5.36±1.90,有统计学差异(P<0.05),而3 组操作疼痛评分分别为0.95±2.35、1.14±2.64、0.72±1.91,无统计学差异(P>0.05).结论:斯康杜尼对上颌磨牙颊侧浸润麻醉与传统的阻滞麻醉在操作疼痛评分差异无显著性,但是注射疼痛显著低于阻滞麻醉.提示斯康杜尼颊侧浸润麻醉即可获得较好的上颌磨牙牙髓麻醉效果.     

心血管病患者拔牙阿替卡因肾上腺素局麻临床效果观察

目的 比较局部麻醉剂阿替卡因肾上腺素和利多卡因用于老年心血管疾病患者拔牙时,对患者血压和心率等变化的影响,探寻阿替卡因肾上腺素用于老年心血管疾病患者拔牙的安全性.方法 本研究包括 228 例老年心血管疾病患者的 239 颗牙齿,随机分组为阿替卡因肾上腺素组(实验组)和利多卡因组(对照组),分别记录麻醉注射前3min,麻醉注射即刻,麻醉注射后3min、拔牙手术中、拔牙手术后3min患者的血压、心率.对数据进行统计分析.结果 与利多卡因相比,阿替卡因肾上腺素在麻醉注射即刻、拔牙手术中心率明显加快,差异具有统计学意义(P<0.05).在麻醉注射后3min收缩压升高,差异具有统计学意义(P<0.05).在任何时点舒张压均无明显升高.两组在麻醉注射后、拔牙手术后血压、心率均回复到麻醉注射前水平.结论 局部麻醉剂阿替卡因肾上腺素对无心动过速、经过全身系统治疗的、病情稳定的心血管疾病患者拔牙是安全可行的.     

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.     

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.     

Anesthetic efficacy of the palatal-anterior superior alveolar injection

BACKGROUND: A single palatal-anterior superior alveolar, or P-ASA, injection has been reported to provide pulpal anesthesia of the four maxillary incisors and usually the canines. The authors conducted a prospective, randomized, double-blind study to compare the anesthetic efficacy of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine using a computer-assisted injection system to administer the P-ASA injection. MATERIALS AND METHODS: In a double-blind manner, the authors used a crossover design to administer randomly P-ASA injections of 1.4 milliliters of the lidocaine solution and 1.4 mL of the mepivacaine solution using the computer-assisted injection system at two appointments to 40 subjects. They used a pulp tester to test for anesthesia of the central incisors, lateral incisors and canines in four-minute cycles for 72 minutes. Anesthesia was considered successful when two consecutive maximum readings (80 readings) with the pulp tester were obtained. RESULTS: For the lidocaine solution, successful pulpal anesthesia ranged from 32 to 58 percent for the six anterior teeth. For the mepivacaine solution, successful pulpal anesthesia ranged from 22 to 38 percent. Except for the left canine, the lidocaine solution was significantly more likely to result in pulpal anesthesia than the use of the mepivacaine solution. The duration of pulpal anesthesia, for both solutions, declined steadily over 72 minutes. CONCLUSIONS AND CLINICAL IMPLICATIONS: Using the computer-assisted injection system for the P-ASA injection, we concluded that the rather modest-to-low success rates of the lidocaine and mepivacaine solutions would not ensure predictable pulpal anesthesia of the four maxillary incisors and the canines.     

A Prospective,Randomized, Double-blind Comparison of the Anesthetic Efficacy of Two Percent Lidocaine with 1:100,000 and 1:50,000 Epinephrine and Three Percent Mepivacaine in the Intraoral,Infraorbital Nerve Block

IntroductionThe purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine in the intraoral, infraorbital nerve block.MethodsForty subjects randomly received intraoral, infraorbital nerve blocks by using a cartridge of 2% lidocaine with 1:100,000 or 1:50,000 epinephrine and a cartridge of 3% mepivacaine at 3 separate appointments spaced at least 1 week apart. The anteriors, premolars, and first molar were pulp tested in 4-minute cycles for a total of 60 minutes.Results and ConclusionsThe intraoral, infraorbital nerve block was ineffective in providing profound pulpal anesthesia of the maxillary central incisor, lateral incisor, and first molar. Successful pulpal anesthesia of the canine and first and second premolars ranged from 75%–92% by using 2% lidocaine with 1:100,000 and 1:50,000 epinephrine. However, pulpal anesthesia did not last for 60 minutes. The use of 3% mepivacaine provided a shorter duration of anesthesia than the lidocaine formulations with epinephrine in the canines and premolars.     

Anesthetic efficacy and heart rate effects of the supplemental intraosseous injection of 2% mepivacaine with 1:20,000 levonordefrin

OBJECTIVE: The purpose of this study was to determine the anesthetic efficacy and heart rate effects of a supplemental intraosseous injection of 2% mepivacaine with 1:20,000 levonordefrin. STUDY DESIGN: Through use of a repeated-measures design, 40 subjects randomly received 3 combinations of injections at 3 separate appointments. The combinations were as follows: inferior alveolar nerve (IAN) block (with 3% mepivacaine) + intraosseous injection of 1.8 mL of 2% mepivacaine with 1:20,000 levonordefrin; IAN block + intraosseous injection of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine (positive control); IAN block + mock intraosseous injection (negative control). Each first molar, second molar, and second premolar was blindly tested with a pulp tester at 2-minute cycles for 60 minutes after injection. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. Heart rate (pulse rate) was measured with a pulse oximeter. RESULTS: One hundred percent of the subjects had lip numbness with the IAN block + intraosseous mock technique and IAN block + intraosseous techniques. The anesthetic success rates for IAN block + mock intraosseous injection, IAN block + intraosseous lidocaine, and IAN block + intraosseous mepivacaine, respectively, were as follows: 80%, 100%, and 100% for the first molar; 90%, 100%, and 100% for the second molar; 77%, 97%, and 97% for the second premolar. For the first molar and second premolar, the differences were significant (P< .05) when the intraosseous mepivacaine and lidocaine techniques were compared with the IAN block + mock intraosseous injection. There were no significant differences between the intraosseous mepivacaine and lidocaine techniques. Eighty percent of the subjects had a mean increase in heart rate of 23-24 beats per minute with the intraosseous injection of the mepivacaine and lidocaine solutions; there were no significant differences between results with the 2 solutions. CONCLUSIONS: We concluded that intraosseous injection of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine or 2% mepivacaine with 1:20,000 levonordefrin, used to supplement an IAN block, significantly increased anesthetic success in first molars and second premolars. The 2 solutions were equivalent with regard to intraosseous anesthetic success rate, failure rate, and heart rate increase after IAN block.     

Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine.

BACKGROUND: Because a number of patients have reported an increase in heart rate with the intraosseous, or i.o., injection, it is important to evaluate changes in the cardiovascular system with this injection technique. The purpose of this study was to determine the cardiovascular effects of an i.o. injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. METHODS: With the use of a repeated-measures design, the authors randomly assigned 42 subjects to receive i.o. injections of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine or 1.8 mL of 3 percent mepivacaine in a double-blinded manner at two appointments. At each appointment the authors monitored electrocardiographic findings, cardiac rate, systolic and diastolic blood pressure, and mean arterial pressure before, during and after administration of anesthetic solutions. RESULTS: With the 2 percent lidocaine with 1:100,000 epinephrine solution, 28 (67 percent) of 42 subjects experienced an increase in heart rate that might be attributed to the effect of the epinephrine. In 22 (79 percent) of these subjects, the heart rate returned to within 5 beats of baseline values within four minutes after solution deposition. The authors found no significant increase in heart rate in subjects receiving the 3 percent mepivacaine. No significant differences (P > .05) were found in mean diastolic, mean systolic or mean arterial blood pressure values between the subjects receiving 2 percent lidocaine with 1:100,000 epinephrine and those receiving 3 percent mepivacaine. CONCLUSIONS: The majority of subjects receiving the i.o. injection of the 2 percent lidocaine-epinephrine solution experienced a transient increase in heart rate. No significant increase in heart rate was seen with the i.o. injection of 3 percent mepivacaine. CLINICAL IMPLICATIONS: While patients would likely notice the heart rate increase with the lidocaine-epinephrine solution, it would not be clinically significant in most healthy patients. In patients whose medical condition, drug therapies or epinephrine sensitivity suggests caution, 3 percent mepivacaine is a good alternative for i.o. injections.     

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.     

Efficacy and safety of mepivacaine compared with lidocaine in local anaesthesia in dentistry: a meta‐analysis of randomised controlled trials

The objective of the study was to assess the efficacy and safety of mepivacaine compared with lidocaine used in local anaesthesia in dentistry. Medline, Cochrane Central Register of Controlled Trials, EMBASE, Chinese BioMedical Literature Database, China National Knowledge Infrastructure and WHO International Clinical Trials Registry Platform were searched electronically. Relevant journals and references of studies included were hand‐searched for randomised controlled trials comparing mepivacaine with lidocaine in terms of efficacy and safety. Twenty‐eight studies were included, of which 15 had low risk of bias and 13 had moderate risk of bias. In comparison with 2% lidocaine with 1:100,000 adrenaline, 3% mepivacaine showed a lower success rate (P = 0.05), a shorter onset time of pulpal anaesthesia (P = 0.0005), inferior pain control during injection phase and superior inhibition of heart rate increase (P < 0.0001). In contrast, 2% mepivacaine with 1:100,000 adrenaline gave a higher success rate (P < 0.00001), a similar onset time of pulpal anaesthesia (P = 0.34) and superior pain control during injection phase (P < 0.0001); 2% mepivacaine with 1:20,000 levonordefrin had the same success rate (P = 0.69) and similar onset time of pulpal anaesthesia (P = 0.90). In addition, 3% mepivacaine had shorter onset time (P = 0.004), same level of success rate (P = 0.28) and similar pain control during injection and postinjection compared with 2% lidocaine with 1:50,000 adrenaline. Given the efficacy and safety of the two solutions, 2% mepivacaine with vasoconstrictors is better than 2% lidocaine with vasoconstrictors in dental treatment. Meanwhile, 3% plain mepivacaine is better for patients with cardiac diseases.