A prospective randomized double-blind study to assess the latency and efficacy of Twin-mix and 2 % lignocaine with 1:200,000 epinephrine in surgical removal of impacted mandibular third molars: a pilot study

Abstract

The addition of dexamethasone to lignocaine and its administration as an intra-space injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

A systematic review and meta‐analysis of perineural dexamethasone for peripheral nerve blocks

“…All but six studies [20, 35-37, 39, 47] examined brachial plexus blockade: interscalene [16,17,21,45,46,53]; supraclavicular [19, 28, 38, 40-44, 48-50, 52, 54, 55] or axillary [18,51,56]. The injection was placed under ultrasound guidance [17, 19-21, 36, 37, 45, 46, 48, 50, 54], with a nerve stimulator [16,18,40,42,49,[51][52][53]55] or following anatomical landmarks [28,35,38,39,41,43,44,47,56], and was supplemented by general anaesthesia in seven RCTs [16,17,21,37,45,46,53] or spinal anaesthesia in one RCT [36]. The administered dose of dexamethasone was 4 mg [28,35,39 [16].…”

“…The injection was placed under ultrasound guidance [17, 19-21, 36, 37, 45, 46, 48, 50, 54], with a nerve stimulator [16,18,40,42,49,[51][52][53]55] or following anatomical landmarks [28,35,38,39,41,43,44,47,56], and was supplemented by general anaesthesia in seven RCTs [16,17,21,37,45,46,53] or spinal anaesthesia in one RCT [36]. The administered dose of dexamethasone was 4 mg [28,35,39 [16]. Local anaesthetics with short-term [18,35,39,40,51,[54][55][56] or medium-term [19] action were injected in nine RCTs, while 20 RCTs injected local anaesthetics with longterm action [16, 17, 20, 21, 28, 36-38, 41-50, 52, 53].…”

“…The administered dose of dexamethasone was 4 mg [28,35,39 [16]. Local anaesthetics with short-term [18,35,39,40,51,[54][55][56] or medium-term [19] action were injected in nine RCTs, while 20 RCTs injected local anaesthetics with longterm action [16, 17, 20, 21, 28, 36-38, 41-50, 52, 53]. With two exceptions [35,39], RCTs used 10-50 ml of injectate.…”

“…For example, peripheral nerve blocks were combined with general anaesthesia in about 25% of the articles. The method of nerve location varied (anatomical landmarks, nerve stimulator or ultrasound-guided), as did the volume of local anaesthetics and the addition of other perineural adjuncts, such as adrenaline [20,28,35,39,40,43,48,49,53,55] or adrenaline and clonidine [21]. Each of these factors may contribute to the substantial heterogeneity observed in the primary outcome.…”

Twin-mix anesthesia as pterygomandibular nerve block for surgical removal of impacted mandibular third molars

“…The addition of dexamethasone to lignocaine solution with adrenaline increases the pH of the solution and thereby raises the amount of free base of the local anesthetic, decreases the time required for the onset of the anesthetic, decreases pain/ sting on injection, increases the duration of soft tissue anesthesia, and also improves the patient's overall postoperative comfort and quality of life as demonstrated by the postoperative VAS scores in clinical trials [2]. The preoperative administration of corticosteroids demonstrating better clinical outcome was emphasized by Tiwana et al in their study on corticosteroids with third molar surgery in patients at high risk for delayed health-related quality of life and clinical recovery [3].…”