Anesthesia Progress Blog - Part 133

Local Anesthesia Techniques in Children Receiving Nitrous Oxide-Oxygen Sedation. METHODS

The aim of this study was to test the hypothesis that dental pain control using infiltration/intrapapillary injection was less effective than inferior alveolar block/long buccal infiltration anesthesia in children. A total of 101 healthy children, aged 5-8 years, who had no contraindication for local anesthetic and who needed a pulpot-omy treatment and stainless steel crown placement in a lower primary molar were studied. A 2-group randomized blinded controlled design was employed comparing the 2 local anesthesia techniques using 2% lidocaine, 1:100,000 epinephrine. All children were given 40% nitrous oxide. Children self-reported pain using the Color Analogue Scale. The study was conducted in a private pediatric dental practice in Mount Vernon, Wash. Overall pain levels reported by the children were low, and there were no differences between conditions at any point in the procedure. Pain reports for clamp placement were block/long buccal 2.8 and infiltration/intrapapillary 1.9 (P = .1). Pain reports for drilling were block/long buccal 2.0 and infiltration/intrapapillary 1.8 (P = .7). Nine percent of children required supplementary local anesthetic: 4 of 52 (7.7%) in the block/long buccal group and 5 of 49 (10.2%) in the infiltration/intrapapillary group (P = .07). The hypothesis that block/long buccal would be more effective than infiltration/intrapapillary was not supported. There was no difference in pain control effectiveness between infiltration/intrapapillary injection and inferior alveolar block/long buccal infiltration using 2% lidocaine with 1:100,000 epinephrine when mandibular primary molars received pulpotomy treatment and stainless steel crowns.

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Nondiabetic Diabetic DISCUSSIONAlthough it is well known that stress can increase blood glucose levels, as shown in previous experimental studies in *diabetic and nondiabetic animals and humans, it is difficult to standardize the type of stress and to generalize the conclusions from one study to another.

Some authors consider dental treatment a stressing procedure, and as such it could induce an increase in blood glucose levels.

Although there are conflicting reports regarding the effect of diazepam on blood glucose concentration in humans, the use of benzodiazepines to control anxiety is widely accepted.

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The Figure shows the pooled values of all volunteers for each session and time of blood collection. In the Table, it can be seen that there were significant differences between the 2 groups, diabetics and nondiabetics, among sessions and times of blood samples (P = .00003); the diabetic group showed higher values than the nondiabetic group. In each group no differences were found among sessions and times of blood samples (P > .05).

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Ethical approval for this investigation was obtained from the Ethical Committee in Research at the Piracicaba Dental School/University of Campinas (UNICAMP). Twenty volunteers took part in this study: 10 *non-insulin-dependent subjects (mean age 48.4 ± 6.65 years) and 10 healthy subjects (mean age 41.9 ± 11.67 years).

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Nondiabetic and Non-Insulin-dependent Diabetic

Anxiety and fear are frequently related to dental treatment and are of major concern to dentists. Stress can lead to an undesirable increase of heart rate, blood pressure, and blood glucose levels. The fight or flight response caused by stress includes sympathetic discharge and elevations in circulating levels of catecholamines, glucocorticoids, and growth hormone, resulting in an increase of blood glucose levels.

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Local Anesthesia

The application of capsaicin to the rat TMJ region resulted in an inflammatory reaction illustrated by the expansion of the periarticular tissue and plasma extravasation as demonstrated by Evan’s blue dye staining in this area of interest. Since capsaicin binds to VR1 receptors located on primary sensory afferents innervating the rat TMJ region to produce edema and plasma extravasation, the findings in this study suggest that acute inflammation of the rat TMJ region encompasses a neurogenic component. In addition, sustained and reversible increase in ipsilateral masseter and digastric muscle activities were evoked with the deposition of capsaicin into the rat TMJ region.

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Local Anesthesia. RESULTS

Among the 64 rats used in this experiment, only data obtained from 48 rats were deemed suitable for analysis. Twelve rats either responded to the injection of saline and the resultant increased EMG activity did not return to baseline levels prior to the injection of capsaicin/ve-hicle, or the application of the preload agent failed to induce a straight lateral movement of the edema measurement needle. In 2 rats, the application of 1% capsaicin to the bupivacaine pretreated TMJ region led to reflex jaw muscle activity, which indicated an unsuccessful nerve conduction blockade. Moreover, there was an absence of blue PE staining in the TMJ region of 2 other rats. Therefore, for the measurement of tissue expansion, each experimental group consisted of 8 rats each, and for the EMG recording of jaw muscle activity, groups 1 and 2 consisted of 6 rats, group 3 consisted of 10 rats, and groups 4-6 consisted of 8 rats each.

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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.