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。     

Efficacy of diphenhydramine hydrochloride for local anesthesia before oral surgery

The efficacy of diphenhydramine hydrochloride with epinephrine was tested against lidocaine with epinephrine in a double-blind study. Patients with allergic reactions to general local anesthetics were safely and effectively treated with diphenhydramine hydrochloride as an anesthetic alternative.     

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.     

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis

Objective. To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed.Study Design. Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful.Results. Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent () of the initial intraosseous injections resulted in solution being expressed into the oral cavity; these were considered technique failures.Conclusions. For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.     

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口腔局部麻醉并发症是指在口腔局部麻醉过程中及麻醉后,由局部麻醉方法、局麻药品或患者自身因素引起的一系列症状或疾病,可分为局部并发症和全身并发症。不同的患者对口腔局部麻醉有着不一样的反应,会出现很多难以避免的并发症。本文就口腔局部麻醉并发症的原因、临床表现、临床处理方法和预防措施做一阐述。     

Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block

OBJECTIVE: The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block. STUDY DESIGN: Through use of a repeated-measures design, each of 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were (1) an inferior alveolar nerve block (with 1.8 mL of 3% mepivacaine) + intraosseous injection with 1.8 mL of 3% mepivacaine and (2) an inferior alveolar nerve (with 1. 8 mL of 3% mepivacaine) + mock intraosseous injection. The first molar was blindly pulp tested at 2-minute cycles for 60 minutes postinjection. Anesthesia was considered successful with 2 consecutive 80 readings. Heart rate (pulse rate) was measured with a pulse oximeter. RESULTS: All subjects had lip numbness with both of the inferior alveolar nerve + intraosseous techniques. Anesthetic success for the first molar was significantly increased for 30 minutes with intraosseous injection of mepivacaine in comparison with the inferior alveolar nerve block alone (mock intraosseous injection). Subjects receiving the intraosseous injection of mepivacaine experienced minimal increases in heart rate. CONCLUSIONS: The intraosseous injection of 1.8 mL of 3% mepivacaine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success for 30 minutes in the first molar. The 3% mepivacaine had a minimal effect on heart rate and would be useful in patients with contraindications to epinephrine use.     

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提要：经典的口腔局部麻醉技术已为临床医生熟知,本文着重介绍近年来口腔局部麻醉实施过程中的一些新观念和新方法,包括局麻注射的无痛操作技术、合理的麻醉方式的选择依据、麻醉时间的控制、麻醉作用的逆转,以及经腭入路上牙槽前神经阻滞麻醉技术、上牙槽前中神经阻滞麻醉技术和计算机控制的局麻药物输送系统-牙周韧带内注射技术。     

碳酸利多卡因在口腔颌面外科的临床应用研究

目的观察碳酸利多卡因和盐酸利多卡因用于口腔颌面外科局部麻醉的效果。方法200例按照美国麻醉师协会(ASA)分级为Ⅰ~Ⅱ级择期手术患者,随机分为盐酸利多卡因组(A)100例,碳酸利多卡因组(B)100例。分别观察起效时间、阻滞完全时间、首剂量维持时间、阻滞范围、麻醉效果、不良反应及麻醉前后血压、心率、呼吸、心电图(ECG)和血氧饱和度。结果碳酸利多卡因组的起效时间、阻滞完全时间较盐酸利多卡因组明显缩短,首剂量维持时间、阻滞范围无明显差异,但碳酸利多卡因首剂量维持时间有延长趋势。两组麻醉前后的血压、心率、呼吸、ECG和血氧饱和度均无明显变化。无明显不良反应。结论碳酸利多卡因与盐酸利多卡因相比,起效快,阻滞作用强、阻滞完全时间明显缩短,不良反应小。