颊侧浸润和下牙槽神经阻滞麻醉对下颌第一磨牙牙髓麻醉效果的评价

下牙槽神经阻滞麻醉是治疗下颌磨牙的基本麻醉方法,颊侧浸润麻醉则因下颌磨牙区的致密骨密质阻碍麻醉药液的渗透而不被采用。本研究通过35名成年志愿者比较了下牙槽神经阻滞麻醉和质量分数4％的阿替卡因颊侧浸润麻醉对下颌第一磨牙牙髓的麻醉效果。     

颊侧浸润麻醉对上颌磨牙麻醉效果的临床观察

目的：比较颊侧浸润麻醉与传统阻滞麻醉对上颌磨牙牙髓的麻醉效果。方法：选择因上颌磨牙深龋或牙髓炎患者,患牙在局麻下行去龋或开髓、拔髓操作。麻药为含1：80000肾上腺素的2%利多卡因。患者随机分为A、B、C三组,每组各100例。A组采用颊侧黏膜下浸润麻醉,剂量1.8ml;B组采用与A组相同的黏膜下浸润麻醉,剂量0.9ml;C组采用传统阻滞麻醉,剂量1.8ml。以视觉模拟评分法（VAS）对注射和操作的疼痛程度进行评分,以Kruskal-Wallis方法检验各组间差异。结果：①Kruskal-Wallis检验显示注射疼痛,组间有统计学差异（p〈0.05）,而操作疼痛,组间无统计学差异（p〉0.05）;②Nemenyi法进一步比较各组间注射疼痛的差异,A组与B组无显著性差异（p〉0.05）,而A组与C组、B组和C组之间存在显著性差异（p〈0.05）。结论：对于上颌磨牙的麻醉,颊侧浸润麻醉（1.8ml或0.9ml）与传统的阻滞麻醉在操作疼痛评分中无显著性差异,但是注射疼痛显著低于阻滞麻醉。提示0.9ml含1：80000肾上腺素的2%利多卡因颊侧浸润麻醉即可获得较好的上颌磨牙牙髓麻醉效果。     

2种局麻药对鼻咽癌放疗后下颌磨牙急性牙髓炎麻醉效果比较

目的探讨必兰与斯康杜尼对鼻咽癌患者放射治疗后下颌磨牙急性牙髓炎的麻醉效果。方法选取鼻咽癌患者放射治疗后下颌磨牙急性牙髓炎患者134例,分为必兰组和斯康杜尼组,每组67例,2组均采用颊侧浸润麻醉,进行开髓术,对比2组麻醉效果。结果必兰组麻醉效果优于斯康杜尼组,麻醉效果总体有效率必兰组为95.5%,高于斯康杜尼组的85.1%,2组差异有统计学意义（χ^2=4.17,P=0.125）。结论在鼻咽癌患者放射治疗后下颌磨牙急性牙髓炎的开髓术治疗中,采用必兰进行颊侧浸润麻醉麻醉效果好于斯康杜尼。     

STA髓腔麻醉法在乳磨牙牙髓摘除术中的应用

目的:探讨STA髓腔麻醉法在乳磨牙牙髓炎无痛治疗中的可行性.方法:将就诊的3～9岁儿童中,同颌对称同名乳磨牙明确诊断为乳磨牙牙髓炎的患儿22名(4～7岁),共44颗患牙.每个患儿的2颗乳磨牙中,选取1颗采用STA髓腔麻醉,作为第1组(n=22);另1颗采用STA常规麻醉,其中上颌采用颊侧骨膜上浸润麻醉,下颌采用牙周膜(PDL)麻醉作为第2组(n=22).结果:髓腔麻醉注射时患儿的疼痛程度明显低于常规麻醉(P＜0.05);1 min内开髓揭顶时的麻醉效果较高于常规麻醉.髓腔麻醉下治疗结束后均无软组织麻木感及无自伤性溃疡的发生,患儿对髓腔麻醉更易接受.结论:乳磨牙STA髓腔麻醉法镇痛效果优于传统浸润麻醉.     

2种浓度利多卡因对下颌智牙拔除麻醉效果的影响

目的：探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法：采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100 000肾上腺素（低浓度组）或3 mL 2%利多卡因1∶100 000肾上腺素（高浓度组）行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平（疼痛评估量表,NRS）、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0 软件包对数据进行统计学分析。结果：21例患者（平均年龄24岁）完成试验,其中62%为女性。低浓度组的疼痛水平（1.09,95% CI,0.77~1.41）显著低于高浓度组（1.66,95%CI,1.33-1.99）（P=0.010）。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间（52~63 s）显著快于高浓度组（259~335 s）（P=0.000）。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异（P=0.751）。在疼痛NRS值为1~3的患者中,低浓度组,9例（100%）均在分牙时疼痛（下牙槽神经麻醉深度浅）;高浓度组3例（43%）分牙时疼痛,4例(57%)翻瓣时疼痛（颊神经麻醉深度浅）（P=0.019）。高浓度组麻醉持续时间比低浓度组平均长61 min（52~69 min）（P=0.000）。结论：用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。     

两种局部麻醉方法应用于下颌阻生第三磨牙拔除术的比较

目的 比较下颌高、中位阻生第三磨牙拔除的患者应用无痛口腔局麻仪行牙周膜注射与卡局芯式注射器行下牙槽神经阻滞麻醉注射的麻醉效果.方法 随机选择50例行双侧下颌高、中使阻生第三磨牙拔除术的成人患者,同一患者左右侧随机归入试验组和对照组.试验组应用无痛口腔局麻仪行阻生牙牙周膜局部浸润麻醉,对照组应用卡局芯式注射器行下牙槽神经阻滞麻醉,患者本人对两种麻醉方式的注射疼痛程度及效果进行评价.结果 两组比较,试验组麻醉注射时疼痛的视觉模拟评分法(visual analogue scale,VAS)值为2.48±0.98,对照组为6.12±0.44,差异有统计学意义(=3.501,P＜0.01).麻醉效果试验组患者自评为“优”者44例,对照组为35例,两组差异无统计学意义(H=2.833,P=0.812).结论 应用无痛口腔局麻仪行牙周膜局部浸润麻醉更有利于下颌高、中位阻生牙拔除术中的无痛操作.     

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.     

骨膜下滑润麻醉牙髓切除（断）术临床观察

目的 探索上下颌牙牙髓切除（断）术麻醉效果更好，更理想的麻醉方法。方法 对3767例上下颌牙骨膜下浸润麻醉作牙髓切除（断）术。其中乳牙、上颌牙、下切牙，与相同数量同名牙在骨膜上浸润麻醉切髓作比较，下尖牙及双尖牙与相同数量同名牙在下牙槽神经阻滞麻醉切髓作比较；下磨牙与相同数量同名牙在下牙槽神经阻滞麻醉切髓作比较。结果 乳牙、上颌牙、下颌前牙及双尖牙骨膜下浸润麻醉切髓时基本无痛、总有效率明显高于对照组（P＜0．01）。下磨牙骨膜下浸润麻醉总有效率低于神经阻滞麻醉。结论 乳牙、上颌牙、下前牙及双尖牙采用骨膜下浸润麻醉、下磨牙采用下牙槽神经阻滞麻醉作切髓术麻醉效果较理想。     

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。     

下牙槽神经阻滞麻醉暂时性并发症2例

下牙槽神经阻滞麻醉暂时性并发症２例山东省聊城地区第四人民医院（２５２０００）江涌病例１暂时性复视，患者，女，３５岁，７急性牙髓炎，拟行局麻下开髓，即用２％利多卡因２ｍｌ（含副肾素）行左下牙槽神经阻滞麻醉，注射中病人手指左眼部示意眼部不适，注射后。病人...     

Anesthetic Efficacy of Gow-Gates Nerve Block,Inferior Alveolar Nerve Block,and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective,Randomized Clinical Trial

Introduction

The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis.

不同剂量阿替卡因对不可复性牙髓炎下牙槽神经阻滞麻醉效果的比较

目的:本研究对仅有刺激痛的早期不可复性牙髓炎的患者在下牙槽阻滞麻醉时,比较使用1.7 mL阿替卡因和3.4 mL阿替卡因的麻醉成功率的差异。方法:将76名患者随机分为两组,1.7 mL组和3.4 mL组(两组都为4%阿替卡因与1∶100000的肾上腺素),进行下牙槽阻滞麻醉。根管治疗过程中,使用Heft-Parker视觉模拟量表(VAS)记录患者的疼痛值。对数据进行T检验和卡方检验。结果:72名患者纳入了研究结果,两组的成功率都没有达到100%,组间有显著差异(P<0.001),3.4 mL组有较高的成功率74.4%,1.7 mL组成功率为27.8%。结论:在对下颌第一磨牙进行下牙槽阻滞时,提高阿替卡因的注射剂量可以显著提高麻醉的成功率,但也达不到100%的麻醉成功。     

Articaine infiltration for anesthesia of mandibular first molars

A randomized, controlled trial of 31 healthy volunteers compared 4% articaine with 1:100,000 epinephrine buccal infiltration to buccal plus lingual infiltration of the same dose of drug in achieving pulpal anesthesia of mandibular first molar teeth. Data were compared with efficacy of an inferior alveolar nerve block using 2% lidocaine 1:80,000 epinephrine in a cohort of 27 of the volunteers. Anesthesia was determined using electronic pulp testing. Buccal and buccal plus lingual infiltrations of articaine with epinephrine did not differ in efficacy in obtaining pulpal anesthesia for mandibular permanent first molars (p = 0.17). Efficacy of 4% articaine with epinephrine infiltrations for first molar pulp anesthesia was similar to that of an IANB using lidocaine with epinephrine over a 30-minute study period (96 and 80 episodes of no response to maximal stimulation respectively, p = 0.097). Subjective tooth numbness was more common after IANB than buccal infiltration (p = 0.005). The discomfort of buccal infiltration with articaine was volume dependent (p = 0.017) and similar to that of an IANB.     

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial

Introduction

Previous studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment.

Efficacy of Articaine versus Lidocaine as a Supplemental Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Prospective,Randomized, Double-blind Study

Introduction

Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is often difficult to obtain and often requires supplemental injections after an ineffective inferior alveolar nerve block (IANB). The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars with IP. In addition, the use of articaine for IANB and intraosseous injections was investigated.

Methods

One hundred emergency patients diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000 epinephrine. All patients reported profound lip numbness after IANB. Patients with ineffective IANB (positive pulpal response to cold or pain on access) randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated 5 minutes after deposition of the infiltration solution. Success was defined as no pain or no more than mild pain during endodontic access and instrumentation as measured on a visual analogue scale.

Results

Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine, resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62% for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05).

Conclusions

Supplemental BI with articaine was significantly more effective than lidocaine. The IANB success rate of 4% articaine confirmed published data.     

Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective,Randomized, Double-blind Study

IntroductionThe pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than adequate. Nitrous oxide and clonidine have shown increases in IANB success when administered individually, but their success has not been evaluated when used together. The purpose of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide/oxygen plus an IANB using lidocaine/clonidine on the success of the IANB in patients with symptomatic irreversible pulpitis and to evaluate the effect of clonidine on blood pressure and pulse.MethodsSixty-two emergency patients experiencing moderate to severe pain and a diagnosis of symptomatic irreversible pulpitis were enrolled. Subjects were randomly divided into 2 groups and received nitrous oxide/oxygen and an IANB using 2% lidocaine with either 27 μg clonidine or 18 μg epinephrine as vasoconstrictors. Blood pressure and pulse were recorded before and during the emergency endodontic treatment. Anesthetic success was defined as no or mild pain upon access and instrumentation of the canals.ResultsThe pulpal anesthetic success rate in both treatments was 58%, with no significant difference between the groups. There was no statistically significant difference in pulse or systolic blood pressure with the use of clonidine compared with epinephrine. Diastolic blood pressure was significant.ConclusionsThe use of nitrous/oxide plus the addition of lidocaine/clonidine for the IANB in teeth with symptomatic irreversible pulpitis resulted in no statistically significant difference in anesthetic success of the IANB. There were no statistically significant differences in pulse or systolic blood pressure with the use of clonidine compared with epinephrine; diastolic blood pressure was significant.     

Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial

Objective: This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique.

Materials and methods: This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p?=?.05 level of significance.

Results: Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p?=?.008). There was no significant difference in pain during anaesthetic injection (p?=?.304) or change in systolic (p?=?.80) and diastolic (p?=?.28) blood pressures following injection between the two techniques.

Conclusions: IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.     

The Effect of Cryotherapy Application on the Success Rate of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

IntroductionThis randomized clinical trial assessed the effect of preoperative intraoral cryotherapy application on the success rate of inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP).MethodsOne hundred four patients with SIP were randomly distributed into 2 groups: control and cryotherapy groups. In the control group, patients received an IANB injection with 2% lidocaine. In the cryotherapy group, intraoral cryotherapy application was performed for 5 minutes after the IANB. Endodontic therapy was then conducted 15 minutes after the IANB injection. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered.ResultsAll patients reported profound lip numbness. The overall success rate for the IANBs was 43.3%. In the cryotherapy group, the success rate of the IANBs was 55.8%, whereas in the control group it was 30.8% (P < .05).ConclusionsIntraoral cryotherapy application increased the success rate of IANBs in mandibular molar teeth with SIP. However, supplemental anesthesia techniques may still be required to provide profound pulpal anesthesia in many cases.     

Effect of preoperative tramadol,ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.