Anesthetic Efficacy of a Combination of Hyaluronidase: RESULTS

In: Anesthesia

30 Dec 2009

Twenty-three males and 7 females from age 19 to 43 years (average 24 years) participated in this study. One hundred percent of the subjects had subjective lip and tongue anesthesia with the IAN blocks. The discomfort ratings of solution deposition for the IAN blocks are presented in Table 1. There were no significant differences (P > .05) between the solutions.

Figure 1. Incidence of second molar anesthesia

Figure 1. Incidence of second molar anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Figure 2. Incidence of first molar anesthesia

Figure 2. Incidence of first molar anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Table 1. Percentages and Discomfort Ratings of Solution Deposition

Solution None

Mild

Moderate

Severe

Solution deposition*
Lidocaine 27% (8/30)

53% (16/30)

13% (4/30)

7% (2/30)

Lidocaine with hyaluronidase 30% (9/30)

47% (14/30)

23% (7/30)

0% (0/30)

Figure 3. Incidence of second premolar anesthesia

Figure 3. Incidence of second premolar anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Anesthetic success is presented in Table 2. Success rates for the lidocaine solution ranged from 20 to 81%, and for the lidocaine solution with hyaluronidase success ranged from 23 to 70%. There were no significant differences (P > .05) between the two solutions. The incidence of pulpal anesthesia for the two techniques is presented in Figures 1 through 6.
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Figure 4. Incidence of first premolar anesthesia

Figure 4. Incidence of first premolar anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Table 2. Percentages and Number of Subjects Who Experienced Anesthetic Success

Anesthetic Success
Tooth Lidocaine Lidocaine With Hyaluronidase
Second molar First molar Second premolarf First premolar)* Lateral Central 70% (21/30) 50% (15/30) 52% (15/29) 81% (21/26) 30% (9/30) 20% (6/30) 70% (21/30)* 67% (20/30)* 59% (17/29)* 61% (16/26)* 30% (9/30)* 23% (7/30)*
* There were no significant differences (P > .05) between the solutions.t Premolars were missing due to orthodontic treatment.

The postoperative pain ratings and subjects reporting postoperative trismus are summarized in Table 3 and 4. The lidocaine solution with hyaluronidase had significantly (P < .05) higher pain ratings and percentage of patients reporting trismus.
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Figure 5. Incidence of lateral incisor anesthesia

Figure 5. Incidence of lateral incisor anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Table 3. Percentages and Discomfort Ratings for Postinjection Survey

Solution None Mild Moderate Severe
Day 0*t
Lidocaine 40% (12/30) 47% (14/30) 7% (2/30)

7% (2/30)

Lidocaine with hyaluronidase 20% (6/30) 37% (11/30) 37% (11/30)

10% (3/30)

Day It
Lidocaine 47% (14/30) 43% (13/30) 10% (3/30)

0% (0/30)

Lidocaine with hyaluronidase 20% (6/30) 37% (11/30) 33% (10/30)

10% (3/30)

Day 2f
Lidocaine 80% (24/30) 17% (5/30) 3% (1/30)

0% (0/30)

Lidocaine with hyaluronidase 47% (14/30) 30% (9/30) 20% (6/30)

3% (1/30)

Day 3t
Lidocaine 93% (28/30) 7% (2/30) 0% (0/30)

0% (0/30)

Lidocaine with hyaluronidase 57% (17/30) 37% (11/30) 7% (2/30)

0% (0/30)

* Rating at time subjective numbness t There were significant differences (J wore off.P < .05) between the solutions.

The pH of the solutions were 7.78 for buffered lidocaine with epinephrine and 7.86 for buffered lidocaine with epinephrine plus hyaluronidase.
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Figure 6. Incidence of central incisor anesthesia

Figure 6. Incidence of central incisor anesthesia as determined by lack of response to electrical pulp testing at the maximum setting (percentage of 80/80s) at each postinjection time interval for the 2 anesthetic solutions.

Table 4. Percentage and Number of Subjects Reporting Postoperative Trismus

Solution
Day 0*t
Lidocaine

3% (1/30)

Lidocaine with hyaluronidase

40% (12/30)

Day It
Lidocaine

7% (2/30)

Lidocaine with hyaluronidase

60% (18/30)

Day 2t
Lidocaine

0% (0/30)

Lidocaine with hyaluronidase

23% (7/30)

Day 3t
Lidocaine

0% (0/30)

Lidocaine with hyaluronidase

17% (5/30)

* Rating at time subjective numbness wore off. t There were significant differences (P < .05) between the solutions.

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