Effectiveness of 20% Benzocaine as a Topical Anesthetic for Intraoral Injections: RESULTS

In: Anesthesia

31 Oct 2009

A total of 1080 patients with a mean age of 25 years (range 18-49 years) participated in this study and received a total of 2336 injections. There were 1635 injections (1121 men/514 women) in the inferior alveolar nerve block group with an age range of 18-49 years (mean = 25), 279 injections (197 men/82 women) in the maxillary first molar infiltration group with an age range of 19-43 years (mean = 26), and 422 injections (297 men/125 women) in the maxillary lateral incisor infiltration group with an age range of 19-43 years (mean = 26). Within the inferior alveolar nerve block group, 470 injections received topical anesthetic prior to needle insertion, whereas 1165 did not. In the maxillary lateral incisor infiltration group, 128 injections received topical anesthetic and 294 did not. In the maxillary first molar infiltration group, 122 injections received topical anesthetic prior to needle insertion and 157 received none. The age and sex of each subject, by individual injection within the topical and no topical groups, was not recorded in the original studies.

Table 1. Needle Insertion Pain Ratings by Area of Injection (%)
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Injection Pain Level

Topical

No Topical
Inferior alveolar nerve block (1635 injections) None

124 (26)

371 (32)
Mild

241 (51)

632 (54)
Moderate

91 (19)

146 (13)
Severe

14 (3)

16 (1)
Maxillary posterior infiltration (279 injections) None

62 (51)

71 (45)
Mild

46 (38)

60 (38)
Moderate

12 (10)

25 (16)
Severe

2(2)

KD
Maxillary anterior infiltration (422 injections) None

47 (37)

81 (28)
Mild

59 (46)

150 (51)
Moderate

20 (16)

59 (20)
Severe

2(2)

4(1)

Percent of injections with no pain on needle insertion

Percent of injections with no pain on needle insertion.

The summary of reported pain upon needle insertion for each injection site is found in Table 1. In general, less than 24% of injections were considered to be of moderate-to-severe pain regardless of whether topical anesthetic was used. The Figure shows the needle insertion pain profile (pain vs no pain) for all 3 injection sites with and without topical anesthetic. Logistic regression analysis (controlling for study) for each group (Table 2) found no significant difference in reported needle insertion pain with the use of topical anesthesia compared with nonuse for the inferior alveolar nerve block group (P = .7363) and the maxillary molar infiltration injection group (P = .0994). Logistic regression analysis did find that the application of topical anesthetic significantly (P = .0041) reduced the pain of needle insertion with the maxillary lateral incisor infiltration group (Table 2). revatio 20 mg

Table 2. Logistic Regression Analysis for Topical Anesthetic Use

Injection

Estimate

Standard Error Adjusted Odds Ratio* Lower 95% Confidence Interval Upper 95% Confidence Interval

P

Mandibular block

-0.293

0.870

0.746

0.135

4.11

.7363

Maxillary posterior infiltration

0.544

0.330

1.72

0.902

3.29

.0994

Maxillary anterior infiltration

0.854

0.297

2.35

1.31

4.21

.0041


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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