Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior a...
Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.
Background: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. Method: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. Results: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. Conclusion: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.
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제안 방법
1. In the study group, 1.7 ml of 4% lidocaine with 1:100,000 epinephrine was injected through the pterygomandibular space for the IAN block in the impacted lower third molar surgery.
2. In the comparative group, 1.7 ml of 4% articaine with 1:100,000 epinephrine was injected through the pterygomandibular space for the IAN block in the impacted lower third molar surgery.
The patients were injected with either 4% lidocaine or 4% articaine (both with 1:100,000 epinephrine) as local anesthetic for the IAN block in the surgical removal of the impacted lower third molars. The local anesthetics were prepared immediately before the injections were administered.
Therefore, the aim of this study was to evaluate the efficacy of a high concentration (4%) of standard lidocaine compared with that of 4% articaine for the surgical removal of lower impacted third molars.
To determine the degree of anesthesia, intra-operative VAS measurements were used to compare the efficacy of the local anesthetics. Most previous studies have shown patients who were administered 4% articaine experienced less intra-operative pain than those who received 2% lidocaine [1,14].
대상 데이터
Initially, 23 patients were included in the study. One participant was withdrawn when he did not attend the second surgical appointment.
One participant was withdrawn when he did not attend the second surgical appointment. Therefore, the final sample included 22 patients with a mean age of 21 years. No adverse events were detected during surgery or in the postoperative period.
데이터처리
The statistical analysis of the subjective and objective onset of anesthesia, anesthetic duration, surgical time, and VAS value of intra-operative pain was performed using the paired t-test. Fisher’s exact test was used to analyze the statistical difference in the number of additional anesthetic injections administered in the groups.
이론/모형
The comprehensive pain measurement was performed using the standard visual analogue scale (VAS) at each step. Postoperatively, each patient was instructed to complete a patient record form to evaluate the duration of the local anesthesia, as indicated by recovery of sensation to the lower lip.
성능/효과
Numerous previous studies have confirmed that 4% articaine has a longer duration of anesthetic effect than 2% lidocaine, and the difference is statistically significant [11,20-22]. As shown in this study, 4% articaine also exhibits a longer duration of anesthesia than 4% lidocaine; however, the difference was not statistically significant. The main difference in this study from previous studies is the use of an increased concentration of lidocaine, from 2% to 4%, along with the vasoconstrictor.
In conclusion, the IAN block using 4% articaine was found to be more clinically effective in subjective and objective onsets of anesthesia than with using 4% lidocaine. The VAS measurements showed that 4% lidocaine provided a more adequate analgesia for the lower third molar surgery and less intra-operative pain than those observed with 4% articaine; however, no clinically significant difference was found between the two groups.
Our results showed that 4% articaine and 4% lidocaine, with the same concentration of vasoconstrictor (1:100,000 epinephrine) had similar clinical efficacy in lower third molar surgery. The main difference between the groups was in the subjective and objective onset of anesthesia, with 4% articaine demonstrating a more rapid onset than 4% lidocaine. These results are similar to those from the study by Rebolledo et al.
참고문헌 (21)
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